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Efficacy of Tegoprazan-Amoxicillin vs BQT therapy in the treatment of H.pylori

Nouraldin Ibrahim Hih, Hazem Ayesh, Hiba Hamdar, Amany Abdelhafeez, Mohamed Nasif, Reem J.Saad, Usra I. Ghanem, Anas Khraim

OSF Preprints (OSF Preprints), 2026

Abstract

Tegoprazan-Amoxicillin Dual Therapy vs. Bismuth Quadruple Therapy for H. pylori Eradication Helicobacter pylori (H. pylori) infection remains a global health concern, directly implicated in peptic ulcer disease, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and the development of gastric adenocarcinoma. Despite the universal recommendation for eradication, the efficacy of standard first-line therapies, such as Proton Pump Inhibitor (PPI)-based triple therapy, has precipitously declined worldwide due to rising antimicrobial resistance, particularly to clarithromycin and metronidazole [1]. To counteract this resistance, current international consensus guidelines, including the Maastricht VI/Florence and American College of Gastroenterology (ACG) recommendations, prioritize high-efficacy regimens. The Bismuth Quadruple Therapy (BQT) (a PPI, bismuth salt, and two antibiotics, often tetracycline/amoxicillin and metronidazole/furazolidone) has emerged as a cornerstone of first-line and salvage therapy, achieving generally high eradication rates [2]. However, BQT is hampered by a complex, high-pill burden regimen, frequent adverse events (AEs), and concerns about patient compliance, which can limit its real-world effectiveness [3]. 2. Emergence of Tegoprazan and the Potential of Dual Therapy The sustained and profound acid suppression provided by Tegoprazan is critical for stabilizing the acid-labile amoxicillin and maximizing its concentration and bactericidal…

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