- Design
- Single-centre RCT
- Population
- 79 treatment-naive adults with H. pylori, Korea
- Primary outcome
- Eradication by 13C-urea breath test
- Effect
- 80.0% vs 82.1% (full analysis); 93.1% vs 87.1% if clarithromycin-susceptible
This single-centre Korean trial randomised 79 treatment-naive patients with H. pylori to seven days of fexuprazan 40 mg, a potassium-competitive acid blocker, or 14 days of rabeprazole 20 mg, each with amoxicillin 1 g and clarithromycin 500 mg twice daily. It was published in Medicine in September.
Eradication by urea breath test was 80.0% with fexuprazan and 82.1% with rabeprazole in the full analysis set, and 83.8% versus 88.9% per protocol. In clarithromycin-susceptible strains, rates were 93.1% and 87.1%. Adverse events were similar.
The finding worth keeping is less about fexuprazan than about clarithromycin: both regimens cleared only about 80% overall but above 90% where the strain was susceptible. Where clarithromycin resistance is common, clarithromycin triple therapy without susceptibility testing is a weak choice whatever the acid suppressant.
- Avoid empirical clarithromycin triple therapy where local resistance is high.
- Use susceptibility testing or bismuth quadruple therapy where available.
- A potassium-competitive acid blocker may allow shorter courses, but evidence here is small.
- Confirm eradication with a breath or stool antigen test.
Why it matters
It shows that clarithromycin resistance limits triple therapy even with a stronger acid blocker.
Don't overread it
A 79-patient single-centre trial cannot establish equivalence of the two regimens.
The statistics, in plain English
With about 40 patients per arm, the trial could not show that the regimens are equivalent; 'comparable' here means no significant difference in a small sample. No non-inferiority margin is reported in the abstract.
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