Title : Efficacy and safety of Tegoprazan–Amoxicillin dual therapy versus bismuth-containing quadruple therapy for helicobacter pylori eradication: A systematic review and meta-analysis
Abstract:
Helicobacter pylori infection but is limited by treatment complexity and adverse events. Tegoprazan, a potassium-competitive acid blocker (P-CAB), has emerged as a promising alternative due to its potent acid-suppressive properties. We conducted a systematic review and meta-analysis to compare the efficacy and safety of tegoprazan–amoxicillin dual therapy with bismuth-containing quadruple therapy for first-line H. pylori eradication.
A systematic search of PubMed, Scopus, and Web of Science was performed up to February 2026. Randomized controlled trials comparing Tegoprazan–amoxicillin dual therapy with bismuth-containing quadruple therapy in treatment-naïve adults with H. pylori infection were included. The primary outcome was the eradication rate. Secondary outcomes included treatment compliance and treatment-related adverse events. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using Review Manager 5.4.
Five randomized controlled trials involving 1,198 participants were included. Tegoprazan–amoxicillin dual therapy achieved eradication rates comparable to those of bismuth-containing quadruple therapy (RR = 1.00, 95% CI: 0.91–1.09; P = 0.93). Sensitivity analysis
confirmed the robustness of the findings (RR = 1.04, 95% CI: 0.98–1.11; P = 0.17) and resolved the observed heterogeneity. Treatment compliance was similar between groups (RR
= 1.02, 95% CI: 0.99–1.05; P = 0.18). Compared with quadruple therapy, tegoprazan–amoxicillin dual therapy significantly reduced the risk of dizziness (RR = 0.37, 95% CI: 0.19–0.72), abdominal pain (RR = 0.35, 95% CI: 0.16–0.79), and nausea or vomiting (RR = 0.47, 95% CI: 0.24–0.92), whereas no significant differences were observed for diarrhea, constipation, or skin rash.
Tegoprazan–amoxicillin dual therapy provides eradication efficacy comparable to that of bismuth-containing quadruple therapy while offering a more favorable safety profile. These findings support tegoprazan-based dual therapy as a promising first-line treatment option for H. pylori infection, although additional multinational randomized trials are needed to confirm its effectiveness across diverse populations.
