Gastric Acid Suppression and The Unmet Needs of PPIs

However, recent observations have highlighted some drawbacks associated with PPI use. Firstly, around two-thirds of patients with GERD have insufficient relief of reflux symptoms after the first PPI dose due to their slow onset of action.² Furthermore, about 50% of patients still report symptoms even after 3 days of treatment.²This incomplete acid suppression is further complicated by the necessity to time PPI intake with meals for optimal effectiveness.³ Consequently, current PPIs are not ideal for ‘on-demand’ therapy in non-erosive reflux disease.³ Moreover, PPIs provide no therapeutic value in functional heartburn, except in cases where proven GERD overlaps with functional heartburn.⁴ This issue affects approximately 50% of PPI non-responders and 25% of PPI responders, underscoring the need for improved treatment options.⁵

Let’s hear to what Dr Manu Tandon has to say about the unmet needs of PPIs.

 

Conclusion

Proton pump inhibitors have long been the first-line therapy for gastric acid suppression, yet they come with a plethora of unmet needs. These include slow onset of action, incomplete acid control, mealtime dependency, and sub-optimal on-demand therapy. Consequently, they fall short of being the best anti-secretory agent in gastric acid management.^2,3

References

1. Shanika LGT, Reynolds A, Pattison S, et al. Proton pump inhibitor use: Systematic review of global trends and practices. Eur J Clin Pharmacol. 2023;79(9):1159–1172.
2. Oshima T, Miwa H. Potent potassium-competitive acid blockers: A new era for the treatment of acid-related diseases. J Neurogastroenterol Motil. 2018;24(3):334–344.
3. Herszényi L, Bakucz T, Barabás L, et al. Pharmacological approach to gastric acid suppression: Past, present, and future. Dig Dis. 2020;38(2):104–111.
4. Fass R, Zerbib F, Gyawali CP. AGA clinical practice update on functional heartburn: Expert review. Gastroenterology. 2020;158(8):2286–2293.
5. Lee YY, Wu JCY. Management of patients with functional heartburn. Gastroenterology. 2018;154(8):2018–2021.e1.

For the use of a registered medical practitioner, hospital or laboratory only.

LMRC Code: GGI-CO-A1-AQS-300041558-APPEMC-G24-1176  DOI of 15/07/24 and DOE of 15/08/24