- Design
- Single-centre randomised controlled trial
- Population
- 79 treatment-naive patients with H. pylori infection, Korea
- Primary outcome
- Eradication by urea breath test
- Effect
- 80.0% vs 82.1% (full analysis); clarithromycin-susceptible 93.1% vs 87.1%
This single-centre Korean trial randomised 79 treatment-naive patients with H. pylori to 7-day triple therapy with fexuprazan, a potassium-competitive acid blocker, plus amoxicillin and clarithromycin, or 14-day triple therapy with rabeprazole. Eradication was confirmed by urea breath test.
Eradication was 80.0% with fexuprazan and 82.1% with rabeprazole in the full analysis set. In clarithromycin-susceptible strains, rates were 93.1% and 87.1%. Adverse events were similar.
Potassium-competitive acid blockers allow shorter courses because they suppress acid more reliably. But an 80% cure rate is below the 90% target for first-line therapy, and clarithromycin resistance is common in India. The practical lesson is less about fexuprazan than about clarithromycin: without susceptibility testing, clarithromycin-based triple therapy of any length is likely to underperform.
- Avoid empirical clarithromycin triple therapy where resistance is common
- Prefer bismuth quadruple therapy, or susceptibility-guided treatment, first line
- Note that potassium-competitive acid blockers may allow shorter courses
- Confirm eradication with a breath or stool antigen test
Why it matters
It shows shorter acid-blocker regimens are possible but do not fix clarithromycin resistance.
Don't overread it
This was a small single-centre trial without a formal non-inferiority margin, so equivalence is not proven.
The statistics, in plain English
With 79 patients the trial cannot establish non-inferiority reliably; the similar rates are compatible with a meaningful difference either way. The higher cure rates in susceptible strains show resistance, not the acid blocker, drives most failures.
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