Despite current advances in acid reflux management that improve reflux and nocturnal symptoms, challenges to acid reflux management still remain.

Conventional proton pump inhibitors (PPIs) are widely used as first line therapy to treat acid related diseases including gastroesophageal reflux disease (GERD), gastric and duodenal ulcers and Helicobacter pylori (HP) eradication therapy. However, the therapeutic efficacy of conventional PPIs are limited by (i) relatively slow onset of pharmacological action and may require several doses to achieve optimal acid suppression and symptom relief; (ii) high inter-individual variability in pharmacokinetics due to genetic polymorphisms of cytochrome P450 (CYP) 2C19 metabolism; (iii) instability in acid conditions which require an enteric formulation in clinical use and (iv) unsatisfactory suppression of gastric acid secretion at night, which can significantly impact on patients' sleep quality and quality of life. Newer formulations of conventional PPIs have been developed to circumvent these problems, but these drugs may have minimal advantages for controlling acid suppression compared to conventional PPIs. Meanwhile, the prevalence of GERD has also been increasing in Asia and with it, the incidences of hard to treat cases.

Vonoprazan is a new potassium-competitive acid blocker (P-CAB) with a high solubility and stability over a broad pH range. As these compounds are acid-stable, they do not require an enteric coating and can be taken with food as they are rapidly absorbed. Pharmacokinetic studies have shown that vonoprazan accumulates in parietal cells under both acidic and neutral conditions, and does not require an acidic environment for activation. Its long term stability at the site of action and satisfactory safety and tolerability profile may address the unmet needs of acid related disorders. Vonoprazan received the Health Sciences Authority (HSA) approval in March 2018 in Singapore. Dr Daphne Ang will review the clinical data for vonoprazan in the treatment of acid related disorders.