The oral potassium-competitive acid blocker vonoprazan was superior to the proton pump inhibitor lansoprazole for erosive esophagitis, according to results of the phase 3 PHALCON-EE trial. The 878 patients with healing were re-randomized to receive vonoprazan 10 mg 1 OD, vonoprazan 20 mg, or lansoprazole 15 mg for 24 weeks in the maintenance phase. For maintenance of healing at week 24, vonoprazan was noninferior to lansoprazole in the primary analysis and superior on secondary analysis of healing (80.7% for vonoprazan 20 mg and 79.2% for vonoprazan 10 mg vs 72.0% for lansoprazole; P < .0001 for both comparisons). As expected, serum gastrin increased to a greater extent with vonoprazan than lansoprazole, with levels > 500 pg/mL in 16% of those taking 20 mg at the end of maintenance therapy, the authors report. After stopping vonoprazan, gastrin levels dropped by roughly 60%-65% within 4 weeks. Last May, the FDA approved two vonoprazan based therapies for the treatment of H pylori infection.