Management of acid related disorders: Present and Future

抄録

For the past three decades, proton-pump inhibitors (PPIs) have been the mainstay of treatment of acid related disorders including gastroesophageal reflux disease and nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcers. There is good evidence that PPIs heals upper gastrointestinal mucosal ulcerations through profound acid suppression. Nevertheless, certain high risk patients still develop recurrent ulcers or ulcer bleeding despite receiving regular PPIs, suggesting that acid suppression with PPIs is either incomplete or other factors contribute to recurrent mucosal damage. Recent evidence suggests that combination of PPI and a COX-2 selective NSAID offers the best upper GI protection in arthritis patients with high GI and high cardiovascular risks. Whether vonoprazan, a potassium-competitive acid blocker translates into superior clinical outcome remains uncertain. Recently, there are concerns about the negative impact of PPI on gut dysbiosis and other possible systematic side effects.