S1002 Comparative Efficacy of Novel Potassium-Competitive Acid Blockers and Proton Pump Inhibitors for Erosive Esophagitis: A Systematic Review and Meta-Analysis With Subgroup Insights

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 (PCABs) have emerged as promising alternatives, providing faster and more consistent acid suppression. This study aims to compare the efficacy and safety of PCABs 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 PCABs were comparable to PPIs in achieving endoscopically confirmed healing of EE, with no statistically significant difference between the groups (RR 1.01; 95% CI 0.99-1.04; P = 0.35). Similarly, by week 8, PCABs 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 PCABs compared to PPIs (RR 1.18; 95% CI 1.07-1.30; P = 0.01), suggesting that PCABs may be more effective in advanced EE. Conclusion: PCABs and PPIs demonstrate similar healing rates for EE at 4 and 8 weeks overall. However, PCABs 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.