Potassium Competitive Acid Blocker Better Than Proton Pump Inhibitor in Healing Higher Grades of Erosive Esophagitis

Potassium Competitive Acid Blocker Better Than Proton Pump Inhibitor in Healing Higher Grades of Erosive Esophagitis

Prateek Sharma, MD, FASGE, reviewing Laine L, et al. Gastroenterology 2022 Oct 10.

Erosive esophagitis, a complication of chronic gastroesophageal reflux disease (GERD), is documented in 30% to 50% of GERD patients undergoing endoscopy. Current guidelines recommend proton pump inhibitors (PPIs) as the standard treatment, but a proportion of patients do not demonstrate healing of esophagitis and have persistent symptoms. Recently, studies have been conducted in Asia comparing PPIs versus potassium competitive acid blockers (PCABs) and have found that PCABs demonstrated greater healing rates than the healing rates with PPIs. 

This multicenter, randomized, blinded trial, which spanned 34 sites in Europe and 77 in the United States and occurred from November 2019 to November 2020, compared two different doses of vonoprazan and a dose of lansoprazole in patients with erosive esophagitis. Primary outcomes were patients with healing at an 8-week follow-up and maintenance of the healed area at a 24-week follow-up. The study randomized 1027 patients into the healing phase and 893 with healing into the maintenance phase. 

During the healing phase, vonoprazan was noninferior to lansoprazole for healing by week 8 (92.9% vs 84.6%; 95% confidence interval, 4.5%-12.2%; P<.0001) and noninferior in mean 24-hour heartburn-free days. However, vonoprazan was superior in healing at week 2 for those with Los Angeles (LA) grade C or D esophagitis (70.2% vs 52.6%; P=.0008). 

During the maintenance phase, both doses of vonoprazan were noninferior to the lansoprazole dose for maintenance of healing (vonoprazan 20 mg: 80.7%, vonoprazan 10 mg: 79.2%, and lansoprazole: 72.0%; P<.0001). Both doses of vonoprazan were found to be superior to lansoprazole in maintenance in those with LA grade C or D esophagitis.

Prateek Sharma, MD, FASGE


In a comparison of the PCAB vonoprazan versus the PPI lansoprazole, vonoprazan was noninferior in healing and superior in the maintenance of healing of erosive esophagitis, specifically in patients with higher grades of erosive esophagitis (LA grade C or D) than in those with LA grade A or B esophagitis. 



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Laine L, DeVault K, Katz P, et al. Vonoprazan versus lansoprazole for healing and maintenance of healing of erosive esophagitis: a randomized trial. Gastroenterology 2022 Oct 10. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2022.09.041)

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