Role of Potassium-Competitive Acid Blockers in <i>Helicobacter pylori</i> Eradication

Park, Jong Kyu

doi:2017.17.1.20

Korean J Helicobacter Up Gastrointest Res > Volume 17(1); 2017 > Article

Review

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2017;17(1):20-25.
DOI: https://doi.org/10.7704/kjhugr.2017.17.1.20 Published online March 10, 2017.

Role of Potassium-Competitive Acid Blockers in Helicobacter pylori Eradication

Jong Kyu Park

Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. sajahoooo@naver.com

헬리코박터 제균 치료에서 칼륨 경쟁적 위산분비 억제제의 역할

박종규

울산대학교 의과대학 강릉아산병원 내과학교실

Correspondence: Jong Kyu Park,
Email: sajahoooo@naver.com

Received: 1 February 2017 • Revised: 7 February 2016 • Accepted: 7 February 2017

Abstract

The first-line therapy for Helicobacter pylori infection comprises triple therapy with the combination of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. However, the H. pylori eradication rate after PPI-based triple therapy has fallen below 80% in many countries, and even reached 70% in recent Korean studies. The main cause of eradication failure has been attributed to the increased antibiotic resistance of H. pylori. To overcome the limitations of the current eradication therapy, the maintenance of a high gastric pH, which increases the function of the antibiotics, may be a successful strategy. Potassium-competitive acid blockers (PCABs) inhibit H⁺, K⁺-ATPase in a reversible and K⁺-competitive manner and result in an almost complete inhibition of gastric acid secretion. However, the clinical development of most PCABs has been discontinued owing to their hepatic toxicity or similar efficacy to PPIs. Vonoprazan has a completely different chemical structure and higher pKa value compared with those of other PCABs and produces more potent and sustained acid inhibition. A recent phase III randomized study reported that vonoprazan was highly effective as a component of first-line or second-line triple therapy. In this study, we reviewed the literature regarding the role of PCAB in the eradication of H. pylori.

Key Words: Potassium-competitive acid blocker; Helicobacter pylori