S2118 Seven-Day Tegoprazan Therapy Matches Proton Pump Inhibitors and 14-Day Therapies for H. pylor Eradication With Much Fewer Adverse Events: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Despite guideline-mandated 14-day quadruple therapy, real-world eradication of Helicobacter pylori continues to falter because proton-pump inhibitors (PPIs) give slow, CYP2C19-dependent acid control and carry growing clarithromycin resistance. Potassium-competitive acid blockers such as tegoprazan achieve near-instant, sustained pH > 6 and have delivered non-inferior or superior cure rates in trials while shortening therapy duration and mitigating dyspepsia-related toxicity. Whether a 7-day tegoprazan-based course can match conventional PPI or longer tegoprazan regimens and simultaneously improve tolerability remains a clinically pivotal question for stewardship. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified Randomized Controlled Trials (RCTs) comparing 7-day tegoprazan Therapy versus PPIs or 14-day regimens for H. pylori eradication through May 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed using RoB 2.0. Results: Four RCTs (n = 1,668; 7-day tegoprazan = 841, control = 827) showed identical eradication efficacy confirmed by urea breath test (RR 0.99, 95% CI 0.94-1.04; I² = 0%) with the abbreviated tegoprazan regimen. Serious adverse events (SAEs) fell by 40% (RR 0.60, 95% CI 0.41-0.89; I² = 0%), translating to 1 fewer SAE per ∼43 patients treated. Overall adverse-event rates were numerically lower (RR 0.83, 95% CI 0.63-1.11) but heterogeneous (I² = 82%), while treatment discontinuation remained comparable (RR 0.95, 95% CI 0.62-1.44; I² = 0%). Conclusion: Rapid, potent acid suppression allows a 7-day tegoprazan backbone to deliver guideline-level cure rates while halving serious toxicity versus PPI or longer PCAB courses—an advantage likely driven by briefer antibiotic exposure and gastro-intestinal neutrality of tegoprazan. The negligible heterogeneity for key endpoints and consistent benefit support adoption. High dispersion in any adverse event signals variable adverse events reporting rather than biological inconsistency. Clinically, this regimen offers a streamlined, patient-friendly, cost-aware alternative that aligns with antimicrobial-stewardship goals and may improve global uptake of H. pylori eradication.