Expert Perspectives on Acid Peptic Disease Management and the Role of Vonoprazan in Indian Settings

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Background: Although there are several clinical studies available regarding the management of acid peptic disorders (APD), there is a dearth of studies among clinical experts on their practice. This study aimed to assess clinicians’ perspectives on the management of APD, with particular emphasis on the emerging role of vonoprazan in routine clinical practice in Indian settings. Methodology: This cross-sectional study included 209 clinical experts across India. A validated 22-item questionnaire assessed key aspects of APD management, including epidemiology, diagnostics, treatment practices, challenges related to proton pump inhibitor (PPI) therapy, and perceptions of vonoprazan. Data were analyzed using descriptive statistics. Results: In routine clinical practice, approximately 51% of clinicians reported that about 11–25% of their patients with gastroesophageal reflux disease (GERD) do not respond adequately to PPI therapy, while 49% indicated that nocturnal acid breakthrough is commonly encountered during PPI use. Nearly 63% of respondents emphasized vonoprazan’s unique mechanism of action as its key advantage over PPIs, enabling faster and more prolonged binding to the H⁺/K⁺-ATPase enzyme and providing sustained 24-hour acid suppression. Approximately 42% of clinicians preferred vonoprazan for GERD, while 41.63% favored its use in 11–25% of patients with nonerosive reflux disease, and 38.76% preferred its use across all age groups in PPI-resistant cases. In the setting of NSAID-induced ulcer recurrence, around 55% of respondents reported using vonoprazan in selected cases. Overall, 73% perceived multiple benefits of vonoprazan, including the absence of a requirement for metabolic activation, more rapid intragastric pH elevation, and acid stability with reversible inhibition, allowing meal-independent dosing. Conclusion: This survey highlights important limitations of PPI therapy and strong clinician recognition of vonoprazan’s pharmacological and clinical advantages. The findings suggest strategic use of vonoprazan in patients with an inadequate response to PPIs, particularly in GERD and PPI-resistant cases, positioning it as a valuable therapeutic option for addressing unmet needs in the management of acid-related disorders.