14-Day Keverprazan-Amoxicillin Dual Therapy Versus Bismuth-Containing Quadruple Therapy as First-Line Treatment for Helicobacter pylori Eradication: A Prospective, Single-Center, Randomized Controlled Trial
In brief
Keverprazan dual therapy matched eradication rates, with side effects 19% vs 29%
In a randomized trial of 316 treatment-naive patients, 14-day keverprazan-amoxicillin therapy eradicated Helicobacter pylori in 93.7% of patients who completed treatment, similar to 93.5% with quadruple therapy. Side effects were less common with dual therapy, but this was a single-center study, so results need confirmation in broader patient groups.
- Journal
- Journal of gastroenterology and hepatology (Q1)
- Published
- 13 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Yue Yu, Qiang She, Yan-Bing Ding, Min Zhang, Yao-Yao Li, Zhuo-Qi Liu, et al.
- PMID
- 42869649
- DOI
- 10.1111/jgh.70808
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 15 October 2026): RCT, H. pylori dual therapy vs quadruple
Abstract
BACKGROUND: Keverprazan, a novel potassium-competitive acid blocker (P-CAB), provides stronger and more sustained gastric acid suppression than proton pump inhibitors (PPIs). However, direct comparisons between 14-day keverprazan-amoxicillin (KA) dual therapy and 14-day bismuth-containing quadruple therapy (BQT) for Helicobacter pylori (H. pylori) eradication remain limited. OBJECTIVE: This study compared the efficacy and safety of the 14-day KA dual therapy versus BQT as a first-line therapy for H. pylori eradication. METHODS: This randomized controlled trial (RCT) recruited 316 treatment-naive, H. pylori-infected patients. Participants were randomly assigned to receive either the KA group (keverprazan 20 mg twice daily + amoxicillin 1000 mg three times daily) or the BQT group (esomeprazole 20 mg twice daily + amoxicillin 1000 mg twice daily + clarithromycin 500 mg twice daily + colloidal bismuth pectin 300 mg twice daily). H. pylori eradication rate was the primary outcome. Adverse events and compliance were considered as secondary outcomes. RESULTS: KA dual therapy was noninferior to BQT in eradication rates across intention-to-treat (ITT) analysis (85.4% vs. 82.9%, noninferiority p = 0.001), modified intention-to-treat (MITT) analysis (92.5% vs. 92.9%, noninferiority p < 0.001), and per-protocol (PP) analysis (93.7% vs. 93.5%, noninferiority p < 0.001). Adverse events were significantly lower in the KA group (19.0%) than in the BQT group (28.5%), p = 0.047. CONCLUSION: The trial suggested KA dual therapy was a promising first-line therapy, achieving a 93.7% eradication rate in the PP analysis, with favorable safety and similar compliance compared to BQT. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2400089303.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.