PCABs have pharmacologic advantages, including a rapid onset of acid suppression, prolonged duration of action, and independence from meal timing. In this study, PCAB therapy with tegoprazan (50 mg) demonstrated better efficacy than double split-dose PPI therapy with rabeprazole (20 mg), showing a significantly higher symptom improvement rate, particularly in patients with abnormal esophageal acid exposure (AET>4%). These results suggest that PCAB therapy could be an effective and more convenient therapeutic alternative in PPI-refractory patients, potentially improving medication adherence and overall satisfaction. Despite these encouraging findings, the single-center, retrospective design and relatively short treatment period limit the generalizability of the results. Larger, prospective multicenter studies are warranted to validate the long-term benefits and reproducibility of PCAB therapy. Overall, this investigation provides meaningful clinical insight supporting the evolving role of PCABs in the management of refractory GERD.