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

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 activity at the site of infection [3]. This pharmacological synergy forms the basis of Tegoprazan-Amoxicillin (TA) dual therapy, a simplified, two-drug, high-dose regimen that promises high efficacy with substantially improved tolerability and compliance compared to multi-drug regimens. 3. Rationale for this review: The Knowledge Gap Prior systematic reviews (SRs) have provided valuable but distinct data points, which do not directly address the core comparative efficacy question of the high-dose dual therapy versus the high-efficacy quadruple therapy standard. or example, the review by Purja et al. (2025) [2] evaluated PCAB-based therapies versus traditional proton pump inhibitor (PPI)–based regimens across multiple treatment types. Although comprehensive, the analysis grouped all PCAB regimens together and did not isolate the specific TA dual regimen, making it impossible to determine how TA dual therapy performs relative to BQT. Similarly, Taufiqqurrachman et al. (2025) [4] compared PCAB-BQT with PPI-BQT. Their focus remained on the acid-suppression component within the BQT backbone rather than on simplified dual therapy approaches. As a result, their findings provide insight into the relative performance of PCAB versus PPI when used in BQT, but they do not evaluate TA dual therapy as an independent intervention. References 1. Yang J, Zhang X, Yang L, Wu R, Fan H, Xie N, Gao L, Dong Y, Xie B, Wang Y, Chen X, Yu Y, Zhang D. Comparison of tegoprazan-based high-dose dual therapy versus bismuth-containing quadruple therapy for Helicobacter pylori eradication: a prospective, multicentre, randomised controlled trial in Gansu Province, a high-resistance region of China. Therap Adv Gastroenterol. 2025 Nov 14;18:17562848251391276. doi: 10.1177/17562848251391276. 2. Purja S, Lee Y, Kim E. Tegoprazan as First- and Second-Line Therapy for Eradication of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis. J Dig Dis. 2025 Jul-Aug;26(7-8):305-317. doi: 10.1111/1751-2980.70004 3. Cheng J, Zhao X, Fan C, et al. Tegoprazan dual and quadruple therapy for Helicobacter pylori eradication: a prospective, randomized controlled trial in Beijing, China. Front Med (Lausanne). 2025;12:1629567. Published 2025 Aug 12. doi:10.3389/fmed.2025.1629567 4. Taufiqqurrachman I, Syam AF, Maulahela H, Abdullah M, Miftahussurur M, Yamaoka Y. Comparative Efficacy and Safety of Potassium-Competitive Acid Blocker- and Proton Pump Inhibitor-Based Bismuth Quadruple Therapy for Helicobacter pylori Eradication: A Network Meta-Analysis. Gastro Hep Adv. 2025 May 16;4(9):100705. doi: 10.1016/j.gastha.2025.100705.