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Potassium-competitive acid blocker-associated gastric mucosal lesions
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Kimitoshi Kubo, Noriko Kimura, Mototsugu Kato
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Clin Endosc 2024;57(4):417-423. Published online February 29, 2024
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DOI: https://doi.org/10.5946/ce.2023.279
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 Abstract
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- Since the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), it has been demonstrated to reversibly inhibit gastric acid secretion by engaging in potassium-competitive ionic binding to H+/K+-ATPase. In contrast, proton pump inhibitors (PPIs) achieve H+/K+-ATPase inhibition through covalent binding to cysteine residues of the proton pump. Reported cases have indicated an emerging trend of P-CAB-related gastropathies, similar to those associated with PPIs, as well as unique gastropathies specific to P-CAB use, such as the identification of web-like mucus. Pathologically, parietal cell profusions, which show a positively correlated with hypergastrinemia, have a higher incidence in P-CAB users compared to PPI users. Thus, this review aims to summarize the endoscopic and pathological findings reported to date concerning P-CAB-related gastric mucosal lesions. Additionally, it seeks to discuss the differences between the PPIs and P-CABs in terms of the formation and frequency of associated gastropathies. This review highlights the evident differences in the mechanism of action and potency of acid inhibition between P-CABs and PPIs, notably contributing to differences in the formation and frequency of associated gastropathies. It emphasizes the necessity to distinguish between P-CAB-related and PPI-related gastropathies in the clinical setting.
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Citations
Citations to this article as recorded by  - Whitish gastric mucosa on upper gastrointestinal endoscopy
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2024; 57(2): 277. CrossRef - Vonoprazan-Associated Mucosal Redness: A Report of Two Cases
Masaya Iwamuro, Yoshiyasu Kono, Takehiro Tanaka, Seiji Kawano, Nobumasa Ikeda
Cureus.2024;[Epub] CrossRef
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