(doi:10.24875/NGL.18000007)
Hidekazu Suzuki, Fellowship Training Center and Medical Education Center, Keio University School of Medicine, Tokyo, Japan
ABSTRACT
Gastroesophageal reflux disease (GERD) is a representative disorder of acid-related diseases.
Antisecretory agents such as proton-pump inhibitors (PPIs) are mainly used to treat
these disorders. Recently, in addition to conventional PPIs, potassium-competitive acid
blockers (P-CABs) have been developed as a new class of agents for acid suppression that
acts by inhibiting the gastric H+/K+-ATPase in a K+-competitive manner. On the other hand,
duodenogastroesophageal reflux of bile acid is another promoter of GERD and their associated
complications, such as Barrett’s esophagus and lower esophageal adenocarcinoma.
Therefore, bile acid sequestrants may play a role in this type of reflux. Herein, the roles of
PCABs and bile acid sequestrants in the treatment of GERD are reviewed. There are three
types of P-CABs, one of which is vonoprazan (VPZ), which has a potent and long-lasting
antisecretory effect on H+/K+-ATPase due to its high accumulation and slow clearance from
the stomach. VPZ is now used in Japan for the treatment of reflux esophagitis, inducing
high mucosal healing rate in patients with PPI-resistant refractory reflux esophagitis and
in protecting esophageal epithelia. Bile acid sequestrants, such as cholestyramine, bind to
bile acids and may be physiologically effective in reducing the exposure of bile acid to the
esophageal epithelial surface. While currently, three available P-CABs have different degrees
of effectiveness in the therapy of GERD, that of bile acid sequestrants has not been fully
proven.
Keywords: Key words: Vonoprazan. Tegoprazan. Revaprazan. Cholestyramine.