ANALYSIS OF THE THERAPEUTIC EFFICIENCY OF VONOPRAZAN AND ESOMEPRAZOLE FOR TREATING GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Background: Proton pump inhibitors (PPIs) like esomeprazole (ESMP) are first-line therapies for acid-related symptoms in GERD. However, potassium-competitive acid blockers (PCABs) such as Vonoprazan (VPZ) are emerging alternatives. Comparative data on symptom relief and adverse drug reactions (ADRs), especially among South Asian populations, remain limited, despite the high local prevalence of GERD. Objectives: This study aimed to compare the efficacy in symptom relief and the safety profile, including adverse drug reactions (ADRs), of vonoprazan (VPZ) versus esomeprazole ESMP) in patients with gastroesophageal reflux disease (GERD). Methodology: In this cross- sectional observational study, 1,208 clinically diagnosed GERD patients were equally assigned to receive VPZ (20 mg/day) or ESMP (40 mg/day) for ≥4 weeks. The treatment allocation was non-randomized and based on routine clinical care. The severity of symptoms was assessed using a 9-item Likert scale, while perceived improvement and ADRs were evaluated through a validated questionnaire. Analysis included chi-square tests, Welch’s t-tests, and multivariable regression. Results: VPZ users had significantly lower mean GERD-TEST scores (16.9 ± 2.9) than the Esomeprazole group (21.1 ± 3.0; p < 0.001), representing a large effect size (Cohen’s d = 1.40) and a 28% relative reduction (Δ -4.21, 95% CI: -4.50 to -3.92). Overall, ADR incidence was lower with VPZ (35.8%) than with ESMP (48.3%; p < 0.001). Specific ADRs such as fatigue (8.9% vs 16.7%; p < 0.001), diarrhea (13.6% vs 19.4%), and nausea (5.6% vs 10.1%) were less frequent with Vonoprazan. Multivariable analysis showed that higher BMI (kg/m²) reduced ADR odds with VPZ (OR 0.62; p = 0.02); conversely, female sex (OR 1.14; p = 0.03) and smoking showed a trend toward increased ADRs with ESMP. Conclusion: VPZ offers superior symptom control and a favorable safety profile compared with ESMP. These findings support the potential use of VPZ as a preferred therapeutic alternative in GERD management.