American Foregut Society White Paper Report on the Use of Potassium-Competitive Acid Blockers in the Treatment of Gastroesophageal Reflux Disease
Year: 2025
Type: article
Abstract: Background: Suppression of gastric acid secretion with proton pump inhibitors (PPIs) has been the mainstay of medical treatment for gastroesophageal reflux disease (GERD) for more than 30 years. Members of a newer class of medication, the potassium-competitive acid blockers (P-CABs), can inhibit gastric acid production faster, longer, and more potently than PPIs. In November 2023, vonoprazan became the first P-CAB to receive FDA approval for GERD treatment. Methods: The American Foregut Society (AFS) convened a 13-member panel of expert gastroenterologists and foregut surgeons to produce a white paper report on how clinicians might use P-CABs to treat GERD. After conducting a comprehensive literature review, panelists proposed 20 total statements on key aspects of P-CAB pharmacokinetics, use of P-CABs for erosive esophagitis and non-erosive reflux disease, and P-CAB safety, as well as 13 recommendation statements on how to use a P-CAB in clinical practice. Using RAND/UCLA Appropriateness Methodology, panelists independently voted to rank each statement for appropriateness, and, after panel review and discussion of first-round voting results, statements were accepted, discarded, or modified for a final round of voting. Results: Twenty-three statements were finally accepted (3 on P-CAB pharmacokinetics, 5 on P-CABs for erosive esophagitis, 3 on P-CABs for non-erosive reflux disease, 4 on P-CAB safety, 8 on how to use P-CABs in clinical practice). Conclusions: This AFS white paper report provides the statements accepted by the expert panel on the use of P-CABs in the treatment of GERD, and summarizes the literature review that provided the rationale for those statements.
Institutions: Baylor University Medical Center, Baylor Scott & White Research Institute, University of California, Los Angeles, VA North Texas Health Care System, The University of Texas Southwestern Medical Center, Washington University in St. Louis, MetroHealth, MetroHealth Medical Center, Case Western Reserve University, Weill Cornell Medicine, Yale University, VA Connecticut Healthcare System, University of Southern California, University of California San Diego, Northwestern University
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,900
OpenAlex ID: W4408550200