Efficacy and Safety of Tegoprazan-Containing Versus Proton Pump Inhibitor-Containing Regimens for First Line Helicobacter pylori Eradication-An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

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• Picked for Gastroenterology (top studies of the week, 8 November 2026): Comparative evidence for H. pylori eradication regimens

Abstract

BACKGROUND: Effective acid-suppressing treatment is of vital importance for the successful eradication of Helicobacter pylori (H. pylori). Tegoprazan, which is a potassium-competitive acid blocker (P-CAB), has been evaluated as a substitute for proton pump inhibitors (PPIs) in first-line eradication therapy, but updated evidence from randomized controlled trials (RCTs) remains limited. AIMS: To evaluate and compare the first-line treatment regimens containing tegoprazan with those containing PPIs in terms of efficacy and safety for the eradication of H. pylori infection. METHODS: We searched the literature in PubMed, Embase, Web of Science, CENTRAL, CNKI, Wanfang, and CBM databases for all available years until November 2025. Randomized trials enrolling treatment-naïve adults receiving first-line eradication therapy were eligible. The primary outcome was the rate of eradication success based on an intention-to-treat (ITT) population analysis, while adverse events and treatment adherence were assessed as secondary outcomes. A pooled analysis was conducted using the risk ratio (RR) and its 95% confidence interval (CI), and the reliability of the evidence was rated on the basis of the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Data were available from 11 randomized trials, including 3872 participants and 14 treatment comparisons. In ITT analyses, tegoprazan-containing regimens were associated with higher eradication success than PPI-containing regimens, but the magnitude of benefit was small (85.7% vs. 81.1%; RR = 1.06, 95% CI: 1.03-1.09, p < 0.0001, I2 = 31%; moderate-certainty evidence). The subgroup finding was most favorable for 14-day treatment and quadruple therapy (RR = 1.07, 95% CI: 1.04-1.11; RR = 1.10, 95% CI: 1.05-1.15). Fewer adverse events were reported in tegoprazan groups than in comparator groups (27.1% vs. 30.5%; RR = 0.90, 95% CI: 0.82-0.99, p = 0.03; low-certainty evidence). Treatment adherence was high in both groups, with a small between-group difference and substantial heterogeneity (low-certainty evidence). CONCLUSIONS: Tegoprazan-containing first-line therapy may provide a small improvement in H. pylori eradication compared with PPI-containing therapy, particularly in 14-day quadruple regimens. Current evidence does not establish a clinically meaningful advantage in safety or adherence, and the findings should be interpreted in light of clinical heterogeneity, geographic limitations, and limited evidence in refractory or special populations. Further well-designed randomized trials are needed. TRIAL REGISTRATION: PROSPERO registration ID: CRD420261290197.

Abstract as published, via PubMed.