Comparison of the Efficacy of Proton Pump Inhibitors and Potassium-Competitive Acid Blockers in Achieving and Maintaining Endoscopic Remission in Erosive Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Aim: to compare the efficacy of proton pump inhibitors and potassium-competitive acid blockers (P-CABs) in achieving and maintaining endoscopic remission in erosive gastroesophageal reflux disease. Materials and methods. A systematic literature search using specified keywords was performed through June 17, 2025, in the MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases. Results. A total of 2,758 patients from six studies were included in this systematic review and meta-analysis. The meta-analysis showed a trend in favor of P-CABs at week 4 of therapy, although the difference was not statistically significant: OR = 1.29; 95% CI: 0.93–1.80; p = 0.13. At week 8, P-CABs demonstrated a statistically significant advantage over proton pump inhibitors in achieving endoscopic remission: OR = 1.92; 95% CI: 1.39–2.64; p < 0.0001. P-CABs were also more effective than proton pump inhibitors in maintaining endoscopic remission: OR = 1.77; 95% CI: 1.42–2.21; p < 0.00001. Heterogeneity across these analyses was low ( I 2 = 0–4 %). Conclusion. P-CABs are an effective alternative to proton pump inhibitors for achieving and maintaining endoscopic remission in patients with erosive gastroesophageal reflux disease. Further prospective studies are needed to optimise treatment regimens, assess long-term safety, and compare the efficacy of different agents within the P-CAB class.