Sex-Specific Differences in Helicobacter pylori Eradication Outcomes: Treatment Success and Adverse Events in a Single Tertiary Center in South Korea

Objectives: Successful eradication of Helicobacter pylori is essential for improving patient outcomes and preventing gastric cancer; however, evidence regarding sex-specific differences in treatment success and adverse event profiles remain limited. This study investigated sex-based differences in eradication efficacy and treatment tolerability. Methods: We retrospectively reviewed patients who underwent diagnostic testing, received eradication therapy, and completed post-treatment confirmation testing between 2003 and 2024 at Seoul National University Bundang Hospital. First-line therapy consisted of 10-day sequential therapy, while second-line treatment included 14-day bismuth-based quadruple therapy or 14-day moxifloxacin-based triple therapy. Treatment success and adverse events were evaluated by sex and treatment regimen. Results: Females had lower eradication rates in the overall cohort. The intention-to-treat analysis showed significantly higher success rates in males compared to females in the total population (71.1% vs. 65.1%, p<0.001) and in sequential therapy (70.5% vs. 62.1%, p<0.001), although this pattern was not replicated in the per-protocol results. Adverse events were reported nearly twice as often in females, regardless of the regimen, which may partly explain the reduced rates of successful eradication and increased discontinuation. Conclusions: Sex-based differences influence H. pylori eradication outcomes, with females showing lower treatment success rates and substantially more adverse events. Higher therapy intolerance and dropout rates in females may partially account for reduced effectiveness of eradication therapy, highlighting the need for sex-specific strategies and improved supportive care.