Design: Systematic review and meta-analysis of randomised trials
Population: 5 trials, 1,541 treatment-naive patients with H. pylori
Primary outcome: Intention-to-treat eradication rate
Effect: RR 0.996 (95% CI 0.911 to 1.089) vs bismuth quadruple therapy

A meta-analysis of five randomised trials, 1,541 treatment-naive patients, compared 14 days of tegoprazan, a potassium-competitive acid blocker, plus amoxicillin with bismuth-containing quadruple therapy.

Eradication by intention to treat was similar (RR 0.996, 95% CI 0.911 to 1.089), and stayed so when the comparator was restricted to proton pump inhibitor-based quadruple therapy. Adverse events and discontinuation were generally more frequent with quadruple therapy, though safety reporting was inconsistent.

A simpler regimen with fewer pills could help adherence. Amoxicillin resistance is low in most regions, which suits a two-drug design, but local availability of tegoprazan varies and only five trials are pooled.

Dual tegoprazan-amoxicillin for 14 days is a reasonable first-line option where available
It avoids clarithromycin, which matters where clarithromycin resistance is high
Expect fewer side effects than bismuth quadruple therapy
Confirm eradication with a urea breath or stool antigen test after treatment

Why it matters

A two-drug regimen could replace a four-drug one many patients struggle to complete.

The statistics, in plain English

A risk ratio of 0.996 with an interval from 0.911 to 1.089 means the two regimens performed essentially the same; the worst case for dual therapy is about 9% fewer eradications.