Agago Demeke E, Hanif Najma, Ajay Kumar Ariga Sai, Arsalan Muhammad, Kaur Dhanjal Manpreet, Hanif Lubna, Wei Calvin R
Medicine, Dilchora Hospital, Dire Dawa, ETH.
Medicine, Sindh Medical College, Karachi, PAK.
Cureus. 2024 Jul 22;16(7):e65141. doi: 10.7759/cureus.65141. eCollection 2024 Jul.
This meta-analysis evaluated the efficacy and safety of potassium-competitive acid blockers (PCABs) compared to proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease (GERD). A comprehensive literature search was conducted across multiple databases, and 11 randomized controlled trials comparing PCABs with PPIs were included. The primary outcome was the healing of erosive esophagitis (EE), with secondary outcomes, including relief of heartburn symptoms and adverse events. The analysis included 11 studies and a pooled sample of 4,108 GERD patients. Results showed that PCABs were significantly more effective in healing EE compared to PPIs (OR: 1.67, 95% CI: 1.24-2.24, p<0.01). PCABs also demonstrated a higher rate of complete resolution of heartburn symptoms, although this difference did not reach statistical significance (OR: 1.43, 95% CI: 0.98-2.09, p=0.06). In terms of safety, there was no significant difference in adverse events between PCABs and PPIs (OR: 0.91, 95% CI: 0.79-1.04, p=0.18), including serious adverse events. The superior efficacy of PCABs can be attributed to their unique pharmacological properties, which allow for more rapid and potent acid suppression compared to PPIs. However, the long-term safety profile of PCABs, particularly newer agents, requires further investigation. The study was limited by the predominance of vonoprazan among the PCABs studied and the focus on patients with EE rather than non-erosive reflux disease. In conclusion, this meta-analysis suggests that PCABs are more effective than PPIs in treating GERD, particularly in healing EE, while maintaining a comparable safety profile. Future research should focus on evaluating a wider range of PCABs, assessing their efficacy in non-erosive reflux disease, and investigating their long-term safety in GERD management.
本荟萃分析评估了钾离子竞争性酸阻滞剂（PCABs）与质子泵抑制剂（PPIs）相比在治疗胃食管反流病（GERD）中的疗效和安全性。在多个数据库中进行了全面的文献检索，纳入了11项比较PCABs与PPIs的随机对照试验。主要结局是糜烂性食管炎（EE）的愈合，次要结局包括烧心症状的缓解和不良事件。该分析纳入了11项研究，共4108例GERD患者的汇总样本。结果显示，与PPIs相比，PCABs在愈合EE方面显著更有效（比值比：1.67，95%置信区间：1.24 - 2.24，p<0.01）。PCABs在烧心症状完全缓解率方面也更高，尽管这一差异未达到统计学显著性（比值比：1.43，95%置信区间：0.98 - 2.09，p = 0.06）。在安全性方面，PCABs与PPIs在不良事件方面无显著差异（比值比：0.91，95%置信区间：0.79 - 1.04，p = 0.18），包括严重不良事件。PCABs的卓越疗效可归因于其独特的药理学特性，与PPIs相比，其能实现更快速、强效的抑酸作用。然而，PCABs的长期安全性，尤其是新型药物，仍需进一步研究。该研究的局限性在于所研究的PCABs中沃克吕赞占主导地位，且研究重点为EE患者而非非糜烂性反流病患者。总之，本荟萃分析表明，PCABs在治疗GERD方面比PPIs更有效，尤其是在愈合EE方面，同时保持了相当的安全性。未来的研究应侧重于评估更广泛的PCABs，评估其在非糜烂性反流病中的疗效，并研究其在GERD管理中的长期安全性。
