In first-line Helicobacter pylori (H. pylori) elimination and erosive esophagitis management, Vonoprazan is superior to proton pump inhibitor (PPI); however, it is not inferior in other gastric acid-associated disorders, according to a systematic review and meta-analysis. Researchers compared the safety and effectiveness of potassium-competitive acid blockers (PCAB) and PPI in treating disorders triggered by gastric acid.

Randomized controlled trials of gastric acid-related diseases including H. pylori infection, peptic ulcers, symptomatic gastroesophageal reflux disease (GERD), and erosive esophagitis were explored. For the effectiveness endpoint and treatment-emergent adverse events (TEAEs) as the safety endpoint, the pooled risk ratio (RR) was assessed. To assess the reliability of the study findings, sensitivity analyses were done.

A total of 19 studies with 7023 subjects were examined out of the 710 studies that were screened. In weeks two, four, and eight, the RRs for erosive esophagitis healing with Vonoprazan vs. PPI were 1.09, 1.03, and 1.02, respectively. Between PCAB and PPI, no differences were reported regarding the enhancement of GERD symptoms or the healing of ulcers.

Vonoprazan was shown to have considerably greater first-line H. pylori eradication rates than PPIs (RR: 1.13). Vonoprazan vs. PPI had an overall RR of TEAEs of 1.08. The risk of bias was generally modest. The robustness of the study's findings was further supported by sensitivity analysis.

In the first-line treatment of erosive esophagitis and the elimination of H. pylori, Vonoprazan is superior to PPI, although it is not inferior in the treatment of other disorders caused by stomach acid. Similar results were seen in both treatment groups for short-term safety.