Potassium-competitive acid blockers (PCABs): A novel era in gastric acid suppression

• Author Details:   
• Sourabh D Jain ^*
• Ankit Agrawal
• Arun K Gupta

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Potassium-competitive acid blockers (PCABs) represent a new class of drugs that offer a promising alternative to traditional proton pump inhibitors (PPIs) for the treatment of acid-related gastrointestinal disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease, and Helicobacter pylori infections. Unlike PPIs, which irreversibly inhibit the H⁺/K⁺-ATPase pump, PCABs act by reversibly and competitively blocking the potassium-binding site of the gastric proton pump, resulting in rapid, potent, and sustained suppression of gastric acid secretion. This unique mechanism provides a faster onset of action, longer duration, and improved acid control, especially during nocturnal periods. Moreover, PCABs are not influenced by meal timing or the need for activation in acidic environments, making them more predictable in therapeutic response. Vonoprazan is currently the most extensively studied PCAB, with several others under clinical development. This review highlights the pharmacological advantages, clinical efficacy, safety profile, and potential therapeutic roles of PCABs, underscoring their significance in advancing the management of acid-related diseases and paving the way for a novel era in gastric acid suppression therapy.