Background H. pylori infection has affected approximately 50% of the world’s population, with rates higher in developing countries than in developed ones. Conventional proton-pump inhibitors (PPIs) have been used as first-line treatment for this condition. However, potassium competitive acid blockers (PCABs) were recently developed, which may offer more beneficial effects than PPIs.

This meta-analysis aims to assess the effectiveness of Potassium-competitive acid-blockers against Proton pump inhibitors for the eradication of H. pylori among adults with H. pylori infection.

Methods An electronic search of randomized controlled trials comparing the H pylori eradication rate of P-CAB and PPI-based therapy was done. The quality assessment used the Modified Cochrane risk-of-bias tool, and statistical analysis was performed using ReviewManager 5.4.1

Results Fifteen RCTs with 4129 participants who received H pylori eradication therapy comparing potassium competitive acid blockers (Tegoprazan, Vonoprazan, and YH808) with proton pump inhibitors were analyzed. H. pylori eradication rate of potassium competitive acid blocker-based therapy was higher than that of PPI-based triple therapy (85% vs. 74.6%, RR 1.04, CI 1.10-1.18, p < 0.05). Subgroup analysis showed that PCAB-based regimens had significantly higher eradication rates than PPI in treatment-naive patients and that Vonoprazan based regimen, in particular, had superior eradication rates compared to PPI-based regiments (87.9% vs. 76%, RR 1.04, CI 0.93-1.16 p = 0.53). No significant differences were seen between the Tegoprazan (69% vs. 66%) and YH4808 (85% vs 75%) groups compared to the PPI group. Adverse events were also lower in the PCAB group compared to the PPI group (39.2% vs 40.3%). (IDDF2024-ABS-0298 Figure 1. Forrest plot showing efficacy of PCABS and PPI-based regiments in H pylori eradication)

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Abstract IDDF2024-ABS-0298 Figure 1

Forrest plot showing efficacy of PCABS and PPI-based regiments in H pylori eradication.

Conclusions A significant challenge that is being faced by current PPIs includes nocturnal acid reflux despite treatment with twice-daily PPI and an additional dosage of H2-receptor blocker at bedtime, which deters successful control of gastritis under PPI treatment. Our study shows that potassium competitive acid blockers are effective and have significantly higher eradication rates compared to PPI, with lower incidence of adverse events.