Potassium competitive acid blockers in Barrett’s esophagus: lessons from gastro-esophageal reflux disease and future directions

Barrett's esophagus (BE) is a metaplastic condition predisposing to esophageal adenocarcinoma. Currently, proton pump inhibitors are a mainstay of therapy for gastro-esophageal reflux disease (GERD), a known risk factor for BE, and as a chemopreventive agent in preventing neoplastic progression in BE. Recently, the U.S. Food and Drug Administration approved vonoprazan, part of a new class of acid-suppressive agents called potassium competitive acid blockers (PCABs). While there have been several randomized trials evaluating the use of vonoprazan in GERD management, there are currently limited data on the use of PCABs in BE populations. This review summarizes key existing data of PCABs in acid-related disorders associated with BE, highlights opportunities to explore the potential utility of PCABs in BE-related endpoints, and identifies challenges in the study of PCABs in BE outcomes.