S1030 Efficacy of Potassium Channel Acid Blockers for Non-Erosive Reflux Disease: A Systematic Review and Meta-Analysis

Introduction: Non-erosive reflux disease (NERD) is a prevalent subset of gastroesophageal reflux disease (GERD) characterized by typical reflux symptoms without visible esophageal mucosal damage. Proton pump inhibitors (PPIs), the traditional mainstay of GERD treatment, have limited efficacy in NERD due to slower onset of action and reduced effectiveness for nighttime symptoms. Potassium-competitive acid blockers (PCABs) are a newer class of acid suppressants offering rapid, potent, and sustained acid suppression. They have demonstrated superior symptom relief and mucosal healing in severe reflux esophagitis and efficacy in PPI-resistant GERD. We aim to evaluate the comparative efficacy of PCABs in treating NERD. Methods: A comprehensive search was conducted in PubMed, Cochrane, and Embase up to October 2024, targeting randomized clinical trials involving adult patients with NERD treated with PCABs or placebo. Studies reporting outcomes such as the proportion of heartburn-free days, healing rates, complete symptom resolution, and quality of life assessed by the GERD-Health Related Quality of Life questionnaire were included. The primary outcome analyzed was the proportion of heartburn-free days. Data was extracted and analyzed using comprehensive meta-analysis software. Results: Our analysis included 4 phase III double-blind randomized trials comparing the efficacy of PCABs (tegoprazan 50 mg and vonoprazan 10 mg) to placebo in the treatment of NERD. A total of 1,760 patients were analyzed, with 880 (50%) patients receiving PCABS, and 880 (50%) receiving placebo. The mean proportion of men in the PCAB group was 33.2%, compared to 41.4% in the placebo group. The mean age of patients in the PCAB group was 50.3 (13.7) years, and 50.3 (14.5) years in the placebo group. The average body mass index for the PCAB group was 24.8 (4.2) kg/m2 versus 24.7 (4.2) kg/m2 in the placebo group. Patients in the PCAB group had a significantly higher proportion of heartburn-free days over 4 weeks compared to the placebo group, with a mean difference of 10.9 days (95% confidence interval 4.2-17; P = 0.001). Conclusion: Our meta-analysis provides strong evidence that PCABs significantly alleviate symptoms in patients with NERD. Given the challenges in managing NERD due to the absence of endoscopic abnormalities and the limitations of PPIs, PCABs emerge as an effective therapeutic alternative to enhance symptom control and reduce morbidity in this patient population.