A systematic review and meta-analysis of randomized controlled trials: the effect of potassium-competitive acid blockers on nighttime symptoms of gastroesophageal reflux disease

source extracted confidence: high 2026-04-09
#humans #gastroesophageal-reflux #randomized-controlled-trials-as-topic #proton-pump-inhibitors #heartburn

A systematic review and meta-analysis of randomized controlled trials: the effect of potassium-competitive acid blockers on nighttime symptoms of gastroesophageal reflux disease

Koo et al., 2026 | Esophagus | Meta Analysis

Citation

Koo Thai Hau, Fass Ronnie. A systematic review and meta-analysis of randomized controlled trials: the effect of potassium-competitive acid blockers on nighttime symptoms of gastroesophageal reflux disease. Esophagus. 2026-Apr;23(2):275-291. doi:10.1007/s10388-025-01181-0

Abstract

Potassium-competitive acid blockers (PCABs), a new class of potent and sustained acid-suppressing drugs, have emerged as an alternative to proton pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD) management. However, the specific benefits of PCABs for nocturnal GERD symptoms remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PCAB therapy compared with PPIs or placebo for managing nighttime heartburn and related symptoms in adults with GERD. We systematically searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases from inception to August 8, 2024. We included randomized controlled trials (RCTs) that compared any PCAB (vonoprazan, tegoprazan, or fexuprazan) with either a PPI or placebo in adult GERD patients. The primary outcome was the proportion of patients with complete resolution of nighttime heartburn throughout the treatment period; the secondary outcome was the treatment-emergent adverse events (TEAEs). Meta-analyses were performed using random-effects models with risk ratios (RRs). Sensitivity analyses were used to assess the robustness of the results. Risk of bias was evaluated using the Cochrane RoB 2 tool. Three RCTs were included in the meta-analysis. PCABs significantly increased the likelihood of complete nighttime heartburn resolution compared with PPIs (RR2.29, 95% CI 1.36-3.87; p = 0.002), with no heterogeneity. Safety analysis of the three trials showed no significant difference in TEAE risk (RR0.88, 95% CI 0.53-1.45; p = 0.62). The findings were consistent across all sensitivity analyses. Our study results suggest that PCABs therapy may provide better nighttime heartburn resolution than PPIs.

Key Findings

Our study results suggest that PCABs therapy may provide better nighttime heartburn resolution than PPIs.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population adult gerd
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Gastroesophageal Reflux
  • Randomized Controlled Trials as Topic
  • Proton Pump Inhibitors
  • Heartburn
  • Treatment Outcome
  • Adult
  • Female
  • Male
  • Middle Aged

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Systematic Review, Meta-Analysis, Review
  • Vertical: potassium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09