Efficacy of Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors in Eradication Regimens for Clarithromycin-Resistant Helicobacter pylori: A Systematic Review and Meta-Analysis
Abstract
Background: Clarithromycin resistance represents the primary obstacle to the success of conventional proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) eradication. Potassium-competitive acid blockers (P-CABs) offer faster and more potent acid suppression, which may enhance the efficacy of eradication regimens in this resistant population. The present study aimed to systematically evaluate the comparative efficacy of P-CAB-based versus PPI-based eradication regimens specifically in adult patients with documented clarithromycin-resistant H. pylori infection.
Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. The protocol was prospectively registered in PROSPERO (CRD420261407870). A systematic literature search was performed in Embase; MEDLINE/PubMed; CENTRAL; and Web of Science for articles published from 1 February 2015 to 31 March 2026. The included evidence comprised randomized and non-randomized comparative studies, as well as non-comparative studies. The primary outcome was the H. pylori eradication rate. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model (DerSimonian-Laird method). Risk of bias was assessed using RoB 2 for randomized comparative studies, ROBINS-I for non-randomized comparative studies, and the JBI Critical Appraisal Checklist for Case Series for non-comparative studies.
Results: A total of 20 unique…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 464 participants or records.
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