POTASSIUM-COMPETITIVE ACID BLOCKERS VERSUS PROTON PUMP INHIBITORS FOR HEALING OF ACID-RELATED UPPER GASTROINTESTINAL DISEASES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Acid-related upper gastrointestinal disorders (ARUGDs), including erosive oesophagitis and peptic ulcer disease, are commonly treated with proton pump inhibitors (PPIs). However, delayed onset of action, variable metabolism, and inconsistent acid suppression may limit their healing efficacy. Potassium-competitive acid blockers (PCABs) offer rapid and reversible inhibition of gastric H⁺/K⁺-ATPase and may provide improved mucosal healing. This systematic review and meta-analysis evaluated the comparative effectiveness of PCABs versus PPIs for endoscopic healing of ARUGDs. A comprehensive search of major databases identified seven randomised controlled trials (RCTs) involving 3,289 adults. All studies assessed endoscopic healing after 4–8 weeks of treatment. Using a prespecified fixed-effect model, PCABs demonstrated a small statistical advantage over PPIs (RR 1.02; 95% CI 1.00–1.04). However, this benefit was not significant under the random-effects model (RR 1.02; 95% CI 0.98–1.05). Substantial heterogeneity (I² = 70.28%) was largely driven by one large erosive-oesophagitis trial; removal of this study reduced I² to 29.72%. Subgroup analysis suggested that advantages of PCABs were limited to erosive oesophagitis and longer treatment duration, while healing rates for gastric and duodenal ulcers were comparable. No evidence of publication bias was detected, and the overall certainty of evidence was rated as moderate. Although PCABs, particularly vonoprazan, may provide slightly improved healing in selected settings, the overall incremental benefit over PPIs is modest. Larger, diverse trials are warranted to clarify the clinical significance of PCABs across different acid-related disorders.