Potassium-competitive acid blockers and advances in the management of patients with acid-related diseases - a narrative review

Sep 28, 2026

Uploaded by Kyle

Traditional management of acid-related diseases, including gastroesophageal reflux disease, Helicobacter pylori infection, and peptic ulcer disease, relies mainly on proton pump inhibitors but is limited by imperfect acid-suppression efficacy. This narrative review assesses potassium-competitive acid blockers as a newer strategy with improved pharmacokinetic and pharmacodynamic profiles. It compares pharmacokinetics, pharmacodynamics, clinical efficacy, and safety across agents, using literature from January 2002 to June 2024, and evaluates outcomes in key clinical indications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Acid-related diseases and the role of acid suppression

Limitations of proton pump inhibitors

Rationale for potassium-competitive acid blockers

TYPE Review PUBLISHED 19 December 2025 DOI 10.3389/fphys.2025.1655102 OPEN ACCESS EDITED BY Stephen J. Pandol, Cedars Sinai Medical Center, United States REVIEWED BY Kenta Watanabe, Akita University, Japan Yen-Chun Peng, Taichung Veterans General Hospital, Taiwan *CORRESPONDENCE Peng Li, [lipeng@ccmu.edu.cn](lipeng@ccmu.edu.cn) RECEIVED 27 June 2025 REVISED 07 November 2025 ACCEPTED 21 November 2025 PUBLISHED 19 December 2025 CITATION Qiao X and Li P (2025) Potassium-competitive acid blockers and advances in the management of patients with acid-related diseases: a narrative review. Front. Physiol. 16:1655102 . doi: 10.3389/fphys.2025.1655102 COPYRIGHT © 2025 Qiao and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Potassium-competitive acid blockers and advances in the management of patients with acid-related diseases: a narrative review Xinwei Qiao and Peng Li* Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Disease, Beijing Key Laboratory of Early Gastrointestinal Cancer Medicine and Medical Devices, Beijing, China Traditional management of acid-related diseases, including gastroesophageal reflux disease, Helicobacter pylori infection, and peptic ulcer disease, primarily relies on proton pump inhibitors, which have notable limitations in acid suppression efficacy that hinder optimal treatment outcomes. Potassium-competitive acid blockers offer a novel approach with improved pharmacokinetic and pharmacodynamic properties, enhancing acid suppression and clinical efficacy in acid-related disease management. This narrative review evaluates the role of potassium-competitive acid blockersin acid-related disease management, comparing the pharmacokinetic, pharmacodynamic, clinical efficacy, and safety profiles of currently available agents. A comprehensive literature search from January 2002 to June 2024 was conducted across multiple databases to gather data on the efficacy and safety of potassium-competitive acid blockers. Potassium-competitive acid blockers showed comparable or superior clinical efficacy and generally comparable safety in various clinical settings vs. comparator proton pump inhibitors, particularly in managing erosive esophagitis, H. pylori eradication, and peptic ulcer disease. Potassium-competitive acid blockers, of which vonoprazanis the most well studied, offer comparable or improved therapeutic outcomes over traditional proton pump inhibitors, making them a valid option for several acid-related disease indications. KEYWORDS potassium-competitive acid blockers, gastroesophageal reflux disease, Helicobacter pylori eradication, peptic ulcer disease, narrative review 1 Introduction Acid-related diseases (ARDs), which include gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and Helicobacter pylori infections, continue to be a major healthcare concern despite advances in management strategies (Inatomi et al., 2016) . ARD management primarily involves gastric acid suppression, with current options including proton pump inhibitors (PPIs) that covalently and irreversibly bind to H+ -K+ -ATPase (Oshima and Miwa, 2018) . PPIs have been available for more than 30 years and are considered the cornerstone treatment for patients with ARDs (Turshudzhyan et al., 2022) . However, PPIs: 1) only bind to active proton pumps, 2) have a short half-life, 3) are Frontiers in Physiology 01 [frontiersin.org](frontiersin.org) i

FAQs

What problem with traditional proton pump inhibitor therapy is highlighted?

Proton pump inhibitors may fail to maintain sufficiently prolonged intragastric pH for mucosal healing and effective H. pylori eradication, influenced by factors such as active-pump binding, short half-life, food effects, slow onset, and interindividual pharmacokinetic variability.

How do potassium-competitive acid blockers work differently from PPIs?

Potassium-competitive acid blockers bind to the K+ site of H+/K+ ATPase, forming non-covalent and reversible bonds and competitively binding in both active and inactive proton pumps, leading to improved acid suppression characteristics.

What evidence did the review use to compare effectiveness and safety?

A comprehensive literature search was conducted from January 2002 to June 2024 across multiple databases, evaluating pharmacokinetic, pharmacodynamic, clinical efficacy, and safety profiles versus comparator proton pump inhibitors.

Sep 28, 2026

Uploaded by Kyle