P4879 - Comparative Efficacy of Novel Potassium-Competitive Acid Blockers and Proton Pump Inhibitors for Erosive Esophagitis: A Systematic Review and Meta-Analysis With Subgroup Insights

Raja Chandra Chakinala, MD¹, Abdullah Sultany, MD², Vikash Karmani, MBBS³, Adishwar Rao, MD², Mahathi Kunduru, MD², Jagadeesh Hathwar, MD⁴
1Guthrie Robert Packer Hospital, Department of Gastroenterology, Sayre, PA; 2Guthrie Robert Packer Hospital, Department of Internal Medicine, Sayre, PA; 3Jinnah Sindh Medical University, Karachi, Sindh, Pakistan; 4Guthrie Corning Hospital, Department of Gastroenterology, Sayre, PA

Introduction: Erosive esophagitis (EE) represents a severe form of gastroesophageal reflux disease (GERD) and is commonly managed with proton pump inhibitors (PPIs). Recently, potassium-competitive acid blockers (P-CABs) have emerged as promising alternatives, providing faster and more consistent acid suppression. This study aims to compare the efficacy and safety of P-CABs with PPIs in the management of EE.

Methods: We performed a systematic review and meta-analysis following PRISMA guidelines. Comprehensive searches were conducted across PubMed, Google Scholar, Embase, Web of Science, and Cochrane CENTRAL from database inception through April 2025. Outcomes assessed included endoscopically confirmed healing of EE at weeks 4 and 8, as well as healing by week 8 in patients with severe disease (Los Angeles (LA) Grade C/D). Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for each study. Data synthesis was conducted using a random-effects model regardless of heterogeneity, which was evaluated using the I² statistic. All analyses were performed with Review Manager 5.4.

Results: We initially screened 8,234 articles through a comprehensive search of multiple databases. After applying predefined inclusion and exclusion criteria, 14 randomized controlled trials were included in the final meta-analysis. At week 4, pooled analysis showed that P-CABs were comparable to PPIs in achieving endoscopically confirmed healing of EE, with no statistically significant difference between the groups (Risk Ratio [RR] = 1.01; 95% Confidence Interval [CI]: 0.99–1.04; p = 0.35). Similarly, by week 8, P-CABs did not demonstrate a significant advantage over PPIs in the general population (RR = 1.03; 95% CI: 0.99–1.07; p = 0.14). However, in a subgroup analysis of patients with more severe disease (LA Grade C/D), healing rates at week 8 were significantly higher with P-CABs compared to PPIs (RR = 1.18; 95% CI: 1.07–1.30; p = 0.01), suggesting that P-CABs may be more effective in advanced EE.

Discussion: P-CABs and PPIs demonstrate similar healing rates for EE at 4 and 8 weeks overall. However, P-CABs provide a significant benefit in patients with severe disease (LA Grade C/D), indicating their potential as a preferred treatment option in advanced cases of EE.


Figure: Figure 1. Forest plots of endoscopically confirmed healing of erosive esophagitis at 4 weeks (A) and 8 weeks (B).


Figure: Figure 2. Forest plot of endoscopically confirmed healing of erosive esophagitis at 8 weeks in LA Grade C/D

Disclosures:
Raja Chandra Chakinala indicated no relevant financial relationships.
Abdullah Sultany indicated no relevant financial relationships.
Vikash Karmani indicated no relevant financial relationships.
Adishwar Rao indicated no relevant financial relationships.
Mahathi Kunduru indicated no relevant financial relationships.
Jagadeesh Hathwar indicated no relevant financial relationships.

Raja Chandra Chakinala, MD¹, Abdullah Sultany, MD², Vikash Karmani, MBBS³, Adishwar Rao, MD², Mahathi Kunduru, MD², Jagadeesh Hathwar, MD⁴. P4879 - Comparative Efficacy of Novel Potassium-Competitive Acid Blockers and Proton Pump Inhibitors for Erosive Esophagitis: A Systematic Review and Meta-Analysis With Subgroup Insights, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.