Gastroenterology

AGA Clinical Practice Update: Optimizing use of potassium-competitive acid blockers

November 6, 2024

This expert review from the AGA Institute Governing Board and CPU Committee provides guidance on the use of potassium-competitive acid blockers (P-CABs) in managing acid-related conditions. The recommendations are based on literature review and expert consensus, but do not carry formal evidence ratings due to the absence of systematic reviews.

Best practice advice

• Generally avoid initial use of P-CABs for acid-related conditions in which clinical superiority has not been demonstrated, considering factors like cost and safety data.
• P-CABs may not be cost-effective as first-line therapy compared with double-dose PPIs, even with modest clinical advantages.
• Generally avoid use of P-CABs as first-line therapy for uninvestigated heartburn or nonerosive reflux disease; consider them for patients with documented acid-related reflux who fail twice-daily PPIs.
• Insufficient evidence exists for P-CABs as first-line on-demand therapy for heartburn, but their rapid action may be beneficial in some cases.
• Generally avoid use of P-CABs as first-line therapy for mild erosive esophagitis (grades A/B); they may be considered for patients who don't respond to twice-daily PPIs.
• P-CABs can be used for healing and maintenance in severe erosive esophagitis (grades C/D), but their high cost and lack of comparative studies with double-dose PPIs limit routine use.
• Use P-CABs instead of PPIs in eradication regimens for most patients with H. pylori infection.
• Generally avoid using P-CABs as first-line therapy for treating or preventing peptic ulcer disease.
• There's limited evidence for P-CABs in patients with bleeding gastroduodenal ulcers, but their rapid acid inhibition may warrant consideration in high-risk cases.

Source:

Patel A, et al. (2024, November). Gastroenterology. AGA Clinical Practice Update on Integrating Potassium-Competitive Acid Blockers Into Clinical Practice: Expert Review. https://pubmed.ncbi.nlm.nih.gov/39269391/