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Vonoprazan emerges as a superior therapeutic alternative to traditional proton pump inhibitors for both Helicobacter pylori eradication and the management of GERD.
In a new systematic review and meta-analysis, potassium-competitive acid blockers (PCABs), led by vonoprazan, delivered superior clinical outcomes compared with conventional proton pump inhibitors (PPIs) for both Helicobacter pylori (H. pylori) eradication and gastroesophageal reflux disease (GERD). The findings reinforced the growing role of PCABs as next-generation acid suppressants for tackling acid-related gastrointestinal disorders.
Pooled analysis demonstrated that PCAB-based therapy significantly outperformed conventional PPI therapy across multiple clinically relevant endpoints, including:
Among the available PCABs, vonoprazan consistently demonstrated the greatest therapeutic benefit. It significantly outperformed lansoprazole- and rabeprazole-based regimens for H. pylori eradication, while producing outcomes comparable to esomeprazole.
The advantage was even more pronounced in Los Angeles Grade C/D reflux esophagitis, where vonoprazan increased healing rates more than threefold. Conversely, tegoprazan did not demonstrate a statistically significant advantage over PPIs in the pooled analysis.
Why Are PCABs Gaining Attention?
Successful management of H. pylori infection and GERD depends on sustained gastric acid suppression. Although PPIs remain the standard treatment, their delayed onset of action and variability in acid inhibition can limit therapeutic effectiveness. PCABs inhibit gastric acid secretion through a different mechanism, providing rapid, potent, and sustained acid suppression that boosts antibiotic activity and promotes mucosal healing.
How Was the Evidence Generated?
Researchers systematically reviewed clinical studies retrieved from PubMed, ScienceDirect, and the Wiley Online Library comparing PCAB- and PPI-based therapies for H. pylori infection and GERD. A random-effects meta-analysis pooled efficacy and safety outcomes using odds ratios with 95% confidence intervals.
What Does This Mean for Clinical Practice?
The analysis identifies vonoprazan as the strongest-performing PCAB currently supported by clinical evidence. Its superior eradication efficacy, improved healing in severe GERD, and favorable safety profile position it as an attractive first-line alternative to conventional PPIs, particularly in patients with difficult-to-treat acid-related disorders. Although PCABs as a class demonstrated clinical advantages, the observed benefits were driven primarily by vonoprazan, highlighting the need for additional comparative evidence to define the role of other agents, including tegoprazan.
Caspian Journal of Internal Medicine
Efficacy and safety of potassium-competitive acid blockers in eradicating Helicobacter pylori and treating gastro-esophageal reflux disease: A systematic review and meta-analysis
Ni Nyoman Gita Kharisma Dewi et al.
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