Potassium-Competitive Acid Blockers and Esophagoprotective Agents in the Management of Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux disease (GERD) is a heterogeneous disorder arising from multiple pathophysiological mechanisms, including impairment of the antireflux barrier, transient lower esophageal sphincter relaxations, hiatal hernia, abnormal esophageal acid exposure, defective esophageal clearance, epithelial barrier dysfunction, and visceral hypersensitivity. Consequently, acid suppression alone does not provide adequate symptom control in all patients.Current consensus consider P-CAB drugs, along with proton pump inhibitors, as an option for initial and maintenance therapy for certain disease phenotypes. An additional approach is esophageal protection: the use of drugs that reduce the contact of refluxate with the mucosa and support the restoration of the epithelial barrier. These include alginates, sucralfate and mucoadhesive complexes of hyaluronic acid and chondroitin sulfate. The most justified indications for their use are postprandial heartburn, regurgitation and residual symptoms despite adequate acid suppression. However, the level of evidence for esophageal protectors remains lower than for proton pump inhibitors and P-CABs.The article discusses modern principles of phenotype-oriented drug therapy for gastroesophageal reflux disease, the specifics of using P-CABs and esophagoprotectors as well as an algorithm for managing patients with a suspected refractory form of the disease.