American Foregut Society White Paper Report on the Use of Potassium-Competitive Acid Blockers in the Treatment of Gastroesophageal Reflux Disease

Background: Suppression of gastric acid secretion with proton pump inhibitors (PPIs) has been the mainstay of medical treatment for gastroesophageal reflux disease (GERD) for more than 30 years. Members of a newer class of medication, the potassium-competitive acid blockers (P-CABs), can inhibit gastric acid production faster, longer, and more potently than PPIs. In November 2023, vonoprazan became the first P-CAB to receive FDA approval for GERD treatment. Methods: The American Foregut Society (AFS) convened a 13-member panel of expert gastroenterologists and foregut surgeons to produce a white paper report on how clinicians might use P-CABs to treat GERD. After conducting a comprehensive literature review, panelists proposed 20 total statements on key aspects of P-CAB pharmacokinetics, use of P-CABs for erosive esophagitis and non-erosive reflux disease, and P-CAB safety, as well as 13 recommendation statements on how to use a P-CAB in clinical practice. Using RAND/UCLA Appropriateness Methodology, panelists independently voted to rank each statement for appropriateness, and, after panel review and discussion of first-round voting results, statements were accepted, discarded, or modified for a final round of voting. Results: Twenty-three statements were finally accepted (3 on P-CAB pharmacokinetics, 5 on P-CABs for erosive esophagitis, 3 on P-CABs for non-erosive reflux disease, 4 on P-CAB safety, 8 on how to use P-CABs in clinical practice). Conclusions: This AFS white paper report provides the statements accepted by the expert panel on the use of P-CABs in the treatment of GERD, and summarizes the literature review that provided the rationale for those statements.