Advances in Peptic Ulcer Treatment: Role of Vonoprazan, Tegoprazan, Keverprazan, and Anaprazole

Background: Peptic ulcer disease (PUD) is a common gastrointestinal disorder frequently caused by Helicobacter pylori (H. pylori) infection or the use of non-steroidal anti-inflammatory drugs. It is associated with significant morbidity, particularly when complicated by upper gastrointestinal bleeding. Proton pump inhibitors have long been the standard of care for acid suppression. However, they have limitations, including delayed onset of action, food dependency, and variability in metabolism influenced by genetic polymorphisms. Objective: This review evaluates the comparative efficacy and safety of novel acid-suppressing agents, including potassium-competitive acid blockers such as vonoprazan, tegoprazan, and keverprazan, as well as anaprazole, a structurally modified proton pump inhibitor. Methodology: Findings from several phase three randomized controlled trials were analyzed. These trials compared newer agents with traditional proton pump inhibitors in terms of ulcer healing, symptom relief, rebleeding prevention, and tolerability. Results: Vonoprazan was shown to be as effective as intravenous pantoprazole in preventing rebleeding after endoscopic hemostasis. Tegoprazan and keverprazan achieved similar or superior healing rates compared to lansoprazole. Anaprazole showed consistent efficacy with reduced variability due to its partial non-enzymatic metabolism. Conclusion: These emerging therapies offer promising alternatives by providing more consistent acid suppression, faster symptom resolution, and improved safety profiles compared to conventional proton pump inhibitors.