New Therapeutic Potential of Potassium-Competitive Acid Blockers in the Management of Refractory Gastroesophageal Reflux Disease

Article information

Korean J Helicobacter Up Gastrointest Res. 2025;25(4):307-307

Publication date (electronic) : 2025 December 4

doi : https://doi.org/10.7704/kjhugr.2025.0074

Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea

Corresponding author Cheol Woong Choi, MD, PhD Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea E-mail: luckyace@hanmail.net

Received 2025 October 27; Accepted 2025 November 14.

This study is a consecutive comparative case series evaluating the therapeutic efficacy of potassium-competitive acid blockers (PCABs) in patients with refractory gastroesophageal reflux disease (GERD) who did not respond to conventional proton pump inhibitor (PPI) therapy [1]. Refractory GERD is defined as persistent symptoms despite optimized proton pump inhibitor therapy, with symptoms associated with documented pathological acid exposure [2]. Management of refractory GERD includes lifestyle modification, optimization of anti-secretory therapy, adjunctive pharmacologic agents, and invasive anti-reflux interventions [3]. However, treatment remains challenging, and symptom control is often difficult to achieve.

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.

Notes

Availability of Data and Material

Data sharing not applicable to this article as no datasets were generated or analyzed during the study.

Conflicts of Interest

Dae Gon Ryu, a contributing editor of the Korean Journal of Helicobacter and Upper Gastrointestinal Research, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.

Funding Statement

None

Acknowledgements

None

References

1. Lim NR, Chung WC. The efficacy of potassium-competitive acid blocker compared with double dose of proton pump inhibitor in patients with refractory gastro-esophageal reflux disease: a case-control study. Korean J Helicobacter Up Gastrointest Res 2025;25:350–354.

2. Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2024;73:361–371.

3. Davis TA, Gyawali CP. Refractory gastroesophageal reflux disease: diagnosis and management. J Neurogastroenterol Motil 2024;30:17–28.

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