Safety of long-term use of potassium-competitive acid blockers: a narrative review
- 1The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)
- 2Pujiang County Hospital of Traditional Chinese Medicine
- 3The Second Clinical Medical College of Zhejiang Chinese Medical University
Abstract
Introduction: Potassium-competitive acid blockers (P-CABs) reversibly inhibit gastric H ⁺ /K ⁺ -ATPase, providing rapid and potent acid suppression. They are increasingly used for gastroesophageal reflux disease, peptic ulcer disease, and Helicobacter pylori eradication. As maintenance therapy expands, long-term safety has drawn growing attention.
Objective: To evaluate the available evidence on the long-term safety of P-CABs, distinguishing established findings from potential safety signals.
Methods: This narrative review drew on searches of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov through 30 June 2026. Studies with at least 24 weeks of treatment or follow-up formed the longer-term human evidence base. Evidence was synthesized by safety outcome, considering the specific agent and study design.
Conclusion: Available comparative evidence, predominantly for vonoprazan, has not shown a substantially higher overall adverse event incidence than with proton pump inhibitors (PPIs). Sustained acid suppression can induce hypergastrinemia, which may be accompanied by parietal-cell hyperplasia, fundic gland dilatation, and other endoscopic mucosal changes. Evidence remains insufficient to determine the risks of rare or long-latency outcomes or to generalize long-term findings to all P-CABs. Long-term prescribing should include periodic reassessment of the indication and individualized monitoring.
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BibTeX
@article{bao2026safety,
title = {{Safety of long-term use of potassium-competitive acid blockers: a narrative review}},
author = {Yuqi Bao and Junkang Chen and Jiayu Han and Jingying Le and Haibiao Bao and Dejian Li},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1964932},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1964932/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Safety of long-term use of potassium-competitive acid blockers: a narrative review
AU - Yuqi Bao
AU - Junkang Chen
AU - Jiayu Han
AU - Jingying Le
AU - Haibiao Bao
AU - Dejian Li
PY - 2026
DA - 2026/10/28
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1964932
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1964932/full
AB - Introduction: Potassium-competitive acid blockers (P-CABs) reversibly inhibit gastric H ⁺ /K ⁺ -ATPase, providing rapid and potent acid suppression. They are increasingly used for gastroesophageal reflux disease, peptic ulcer disease, and Helicobacter pylori eradication. As maintenance therapy expands, long-term safety has drawn growing attention. Objective: To evaluate the available evidence on the long-term safety of P-CABs, distinguishing established findings from potential safety signals. Methods: This narrative review drew on searches of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov through 30 June 2026. Studies with at least 24 weeks of treatment or follow-up formed the longer-term human evidence base. Evidence was synthesized by safety outcome, considering the specific agent and study design. Conclusion: Available comparative evidence, predominantly for vonoprazan, has not shown a substantially higher overall adverse event incidence than with proton pump inhibitors (PPIs). Sustained acid suppression can induce hypergastrinemia, which may be accompanied by parietal-cell hyperplasia, fundic gland dilatation, and other endoscopic mucosal changes. Evidence remains insufficient to determine the risks of rare or long-latency outcomes or to generalize long-term findings to all P-CABs. Long-term prescribing should include periodic reassessment of the indication and individualized monitoring.
SN - 1663-9812
ER -