Emerging treatments

Potassium-competitive acid blockers

Potassium-competitive acid blockers (e.g., vonoprazan) may be useful for patients with GORD unresponsive to proton-pump inhibitors (PPIs). Patients with documented acid-related reflux who fail therapy with PPIs may benefit from the use of potassium-competitive acid blockers.[119]​ Although not advised as a first-line option for patients with mild erosive esophagitis (Los Angeles grade A or B), potassium-competitive acid blockers may be considered a therapeutic option for patients with severe erosive oesophagitis (Los Angeles grade C or D).[119]​ Phase 3 trials in patients with erosive oesophagitis report that vonoprazan is non-inferior to lansoprazole (a PPI) and may be superior to lansoprazole for healing more severe oesophagitis.[120][121]​​​​​​ The US Food and Drug Administration (FDA) has approved vonoprazan for healing and maintenance of healing in all grades of erosive oesophagitis, and for relief of heartburn associated with erosive and non-erosive GERD. However, the American Gastroenterological Association advises against the first-line use of these agents in patients with non-erosive reflux disease.[119]​ Vonprazan is not currently approved in Europe.

Endoscopic treatments

Emerging endoscopic treatments include anti-reflux mucosectomy, anti-reflux mucosal ablation, and delivery of radiofrequency energy to the lower oesophageal sphincter (Stretta).[36]​[122][123][124][125]​​ Some studies suggest these treatments may improve symptoms and provide an alternative to long-term PPI use for patients with chronic or refractory GORD, but they not routinely used in clinical practice. Based on low to very low certainty evidence, the American Society for Gastrointestinal Endoscopy suggests that Stretta may be considered for patients with confirmed GORD, a hiatal hernia <2 cm, and Hill grade I or II if alternative treatments are not available or feasible.[36]​ See Criteria.

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