Emerging treatments

Potassium-competitive acid blockers

Potassium-competitive acid blockers (e.g., vonoprazan) may be useful for patients with GERD unresponsive to proton-pump inhibitors (PPIs). Patients with documented acid-related reflux who fail therapy with PPIs may benefit from the use of potassium-competitive acid blockers.[125]​ Although not advised as a first-line option for patients with mild erosive esophagitis (Los Angeles grade A or B), potassium-competitive acid blockers may be considered a therapeutic option for patients with severe erosive esophagitis (Los Angeles grade C or D).[125]​ Phase 3 trials in patients with erosive esophagitis report that vonoprazan is noninferior to lansoprazole (a PPI) and may be superior to lansoprazole for healing more severe esophagitis.[126][127]​​​​​ The Food and Drug Administration (FDA) has approved vonoprazan for healing and maintenance of healing in all grades of erosive esophagitis, and for relief of heartburn associated with erosive and nonerosive GERD. However, the American Gastroenterological Association advises against the first-line use of these agents in patients with nonerosive reflux disease.[125]​ Vonprazan is not currently approved in Europe.

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