Efficacy of Potassium-Competitive Acid Blockers in Functional Dyspepsia: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Functional dyspepsia (FD) is a prevalent gastrointestinal disorder characterized by upper abdominal discomfort, often refractory to standard acid suppression therapy. Potassium-competitive acid blockers (PCABs), such as vonoprazan and tegoprazan, provide rapid and sustained gastric acid inhibition and may represent a therapeutic alternative. However, their efficacy in FD remains unclear. This systematic review and meta-analysis aimed to evaluate the effect of PCAB therapy on symptom outcomes in adults with FD. Methods: A systematic search of PubMed, EMBASE, and Cochrane CENTRAL was conducted from inception to June 13, 2025, to identify studies evaluating PCABs in adult FD patients. Eligible studies included randomized controlled trials and prospective or retrospective cohorts reporting validated symptom scores before and after PCAB therapy. Studies were included in meta-analysis if they reported 4-week outcomes with sufficient data for effect size calculation. Standardized mean differences (SMDs) were pooled using a DerSimonian-Laird random-effects model. Heterogeneity was assessed with the I2 statistic, and robustness was evaluated with leave-one-out sensitivity analysis and Baujat plots. Results: Five studies comprising 366 patients were included. Four treatment arms from three studies (n = 276) were eligible for meta-analysis. The pooled SMD for symptom improvement at 4 weeks was 1.09 (95% confidence interval (CI): 0.67 - 1.52), indicating a moderate-to-large treatment effect in favor of PCABs. Heterogeneity was substantial (I2 = 77.8%), but sensitivity analyses showed that no single study unduly influenced results. The remaining two studies, excluded from quantitative pooling due to incompatible timepoints or outcome structures, also demonstrated statistically significant symptom improvement, supporting consistency of effect across the evidence base. Conclusion: PCABs may offer clinically meaningful symptom relief in FD, with pooled data suggesting a moderate-to-large effect size. While heterogeneity and limited sample size temper generalizability, findings were consistent across studies and robust to sensitivity testing. PCABs show promise as a potential therapeutic option in FD, particularly in patients who do not respond to or cannot tolerate proton pump inhibitors. Further placebo-controlled trials are needed to confirm efficacy and define long-term outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.031 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.051 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".