Clin Endosc.  2024 Jul;57(4):417-423. 10.5946/ce.2023.279.

Potassium-competitive acid blocker-associated gastric mucosal lesions

• Kubo K
• Kimura N
• Kato M

• KMID: 2558095
• DOI: http://doi.org/10.5946/ce.2023.279

Abstract

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.

Keyword

Acid-related disorders; Adverse effects; Potassium-competitive acid blocker; Proton pump inhibitors; Vonoprazan

Figure

• 

  Fig. 1. Endoscopic findings of potassium-competitive acid blocker-related gastric mucosal lesions. (A) Fundic gland polyps. (B) Hyperplastic polyps. (C, D) Multiple white and flat elevated lesions. (E) Cobblestone-like mucosa. (F) Black spots. Written informed consent was obtained from the patients for publication of the case report as part of the review and any accompanying images included.

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  Fig. 2. Endoscopic findings of potassium-competitive acid blocker-related gastric mucosal lesions. (A–C) Gastric mucosal redness observed on white-light imaging (WLI) was highlighted on texture and color enhancement imaging (TXI) mode 1 and narrow-band imaging (NBI), respectively. (D–F) White spots observed on WLI were highlighted on NBI. Magnifying endoscopy with NBI showed the mucosal surface of white spots to be rich in microscopic vessels. (G–I) Web-like mucus observed on WLI was highlighted on TXI mode 1 and NBI, respectively. Written informed consent was obtained from the patients for publication of the case report as part of the review and any accompanying images included.

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