Dual acid-pump blocking as novel therapeutic approach to treatment of acid-related diseases

Abstract

Proton-pump inhibitors are highly efficient in the treatment of acid-related disease; however, their efficacy in treating reflux symptoms, healing esophageal erosions and peptic ulcers and eradicating Helicobacter pylori is sometimes suboptimal. Potassium-competitive acid blockers have a different mechanism of action, resulting in higher and longer-lasting increases in intragastric pH, which is neither non-inferior or superior to those of proton-pump inhibitors. The pharmacology, metabolism and mechanism of action of these drugs are different, therefore, it is hypothesised, that their combined use might be of clinical benefit through increased intragastric pH. This hypothesis is supported by pharmacological, physiological and microbiological data. The combined administration of proton-pump inhibitors and potassium-competitive acid blockers should be investigated in short-term therapy (4–8 weeks); if their complementary or additive effect is proven, dual acid pump blocking can be of further benefit in managing gastroesophageal reflux disease, peptic ulcers and eradicating Helicobacter pylori infection, in cases refractory to current therapies. For safety reasons, long-term administration of this combination as maintenance treatment should be avoided.