Effect of a potassium-competitive acid blocker on the gut microbiota in patients undergoing percutaneous coronary intervention: a randomized pilot study

@article{lee2026effect,
  title = {{Effect of a potassium-competitive acid blocker on the gut microbiota in patients undergoing percutaneous coronary intervention: a randomized pilot study}},
  author = {Sang Hoon Lee and Seong-In Na and Sung Chul Park and Byung Ryul Cho and Bong Ki Lee and Yong-Joon Cho and Hyunseok Cho and Hee-Jeong Youk and Dong Ryeol Ryu},
  journal = {Frontiers in Cellular and Infection Microbiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fcimb.2026.1942212},
  url = {https://doi.org/10.3389/fcimb.2026.1942212},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Effect of a potassium-competitive acid blocker on the gut microbiota in patients undergoing percutaneous coronary intervention: a randomized pilot study
AU  - Sang Hoon Lee
AU  - Seong-In Na
AU  - Sung Chul Park
AU  - Byung Ryul Cho
AU  - Bong Ki Lee
AU  - Yong-Joon Cho
AU  - Hyunseok Cho
AU  - Hee-Jeong Youk
AU  - Dong Ryeol Ryu
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Cellular and Infection Microbiology
DO  - 10.3389/fcimb.2026.1942212
UR  - https://doi.org/10.3389/fcimb.2026.1942212
AB  - Background and aim: Proton pump inhibitors (PPIs) are routinely used in patients undergoing percutaneous coronary intervention (PCI) to prevent gastrointestinal bleeding associated with dual-antiplatelet therapy (DAPT). However, long-term PPI use has been linked to gut microbiota dysbiosis. Tegoprazan, a potassium-competitive acid blocker (P-CAB), may exert distinct effects on the gut microbiome. This study compared the longitudinal effects of tegoprazan and pantoprazole on gut microbiota composition in patients with angina undergoing PCI.  Methods: This prospective, randomized, controlled pilot study randomized 38 patients 1:1:1 to tegoprazan 50 mg once daily, pantoprazole 40 mg once daily, or no acid-suppressive therapy for 24 weeks. Five participants did not provide baseline fecal samples, and nine discontinued participation before week 24. Thus, 24 participants with paired baseline and week-24 fecal samples were included in the final analysis. Fecal samples were analyzed using 16S rRNA gene sequencing.  Results: No drug-related adverse events or gastrointestinal bleeding occurred in any group. Observed amplicon sequence variant (ASV) richness was significantly higher at week 24 than at baseline in the overall cohort (p = 0.003) and P-CAB group (p = 0.016), whereas the Shannon index showed no significant changes. Paired PERMANOVA with permutations restricted by patient ID revealed significant differences in Bray–Curtis beta diversity between baseline and week 24 in the P-CAB group (R² = 0.070, p = 0.031) and PPI group (R² = 0.059, p = 0.008), but not in the no acid-suppressive therapy group (R² = 0.021, p = 0.691). In the formal cross-arm analysis, the treatment group-by-visit interaction was not significant for Bray–Curtis beta diversity (R² = 0.021, pseudo-F = 0.505, p = 0.270). Although nominal within-arm taxonomic changes were observed, no treatment group-by-visit interaction survived Benjamini–Hochberg correction in ANCOM-BC2.  Conclusion: Tegoprazan was well tolerated, with no drug-related adverse events or gastrointestinal bleeding during the 24-week follow-up. Both acid-suppressive treatment groups showed modest longitudinal microbiome changes. The taxon-level findings were exploratory and hypothesis-generating and should not be interpreted as definitive evidence of treatment-specific differential effects. Larger, adequately powered studies are required to confirm these observations.
SN  - 2235-2988
ER  -