Potassium-Competitive Acid Blockers for First-Line Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis

Background and Aims: eradication. Methods: A systematic search of PubMed, ScienceDirect, Cochrane, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials comparing P-CAB-based regimens with B-PPI-based quadruple therapies were included. Pooled risk ratios (RRs) were calculated. The primary outcome was the eradication rate; secondary outcomes were treatment compliance and subgroup analysis according to the specific P-CAB used. In subgroup analyses, no significant differences were confirmed for individual P-CABs. Conclusion: Compared with B-PPI-based quadruple therapy, P-CAB-based regimens showed a small statistical advantage in intention-to-treat analysis, which was not consistently supported by per-protocol or subgroup analyses. No difference in treatment adherence was observed. These findings suggest that P-CAB-based regimens should be considered alternative first-line options rather than clear replacements for standard PPI-based quadruple therapy.