{"paper_id":"120e2c49-28a8-4262-8121-5cdaeb49b7c3","body_text":"Efficacy and Safety of Potassium-Competitive Acid Blockers in Helicobacter pylori Rescue Therapy: A Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy and Safety of Potassium-Competitive Acid Blockers in Helicobacter pylori Rescue Therapy: A Meta-Analysis L. T. Chen, S. Gu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8054000/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Helicobacter pylori (H. pylori) infection is associated with the development of various gastrointestinal pathologies, including gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric adenocarcinoma. Eradication of this pathogen is therefore essential for both the treatment and prevention of these conditions. Potassium-competitive acid blockers (P-CABs), a novel class of acid-suppressive agents, have been extensively incorporated into first-line H. pylori eradication regimens and have demonstrated superior efficacy compared to conventional proton pump inhibitors (PPIs). Nevertheless, their effectiveness in rescue therapy remains a subject of debate. Objective: To evaluate the efficacy and safety of P-CAB-containing regimens in the rescue therapy for H. pylori eradication. Methods: Based on the PRISMA 2020 guideline（Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA 2020 Statement）, A systematic search was conducted across three electronic databases: PubMed, Web of Science, and EMBASE. The primary outcome was the eradication rate assessed by per-protocol (PP) analysis. The secondary outcome was safety. We synthesized the effect sizes using risk difference (RD) and 95% confidence interval (95% CI). Results: A total of 1373 references were retrieved through the search, and 14 studies (2 RCTs and 12 non-RCTs) were included, comparing P-CAB-containing rescue regimens with traditional PPI-containing rescue regimens. The PP analysis included 10,494 patients (P-CABs intervention group: 4498; PPI control group: 5996). A comparison of P-CAB- and PPI-based regimens revealed a statistically significant difference in eradication rates within the context of H. pylori rescue therapy.[RD=0.04, 95% CI=0.03 to 0.04]. Conclusion: P-CAB-based anti- H. pylori regimens are more effective than PPI-based regimens in rescue therapy, with no significant difference in safety. P-CABs Helicobacter pylori Rescue Therapy Safety Figures Figure 1 Figure 2 Figure 3 1. Introduction Helicobacter pylori (H. pylori), as one of the most common pathogenic bacteria in the digestive tract, can cause various diseases such as chronic atrophic gastritis, peptic ulcers, gastric cancer, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Eradicating H. pylori can effectively improve the prognosis of these diseases [1] . Although epidemiological surveys indicate a declining trend in the incidence of H. pylori in developed countries and mainland China, the prevalence remains as high as over 70% in developing countries and some impoverished regions, with a global prevalence rate of about 50% [2–4] Eradicating H. pylori remains highly significant for improving the prognosis of patients with H. pylori -related diseases worldwide. Both the Toronto Consensus and the Maastricht V/Florence Consensus recommend a 14-day H. pylori eradication regimen containing two antibiotics, with or without bismuth, as the first-line treatment [5, 6] . However, increasing resistance rates to metronidazole, clarithromycin, and other commonly used antibiotics, coupled with factors like CYP2C19 gene polymorphism, have led to a year by year decline in the eradication rates of PPI-containing regimens [7–9] . Potassium-competitive acid blockers (P-CABs), as a new class of potent H+/K+-ATPase inhibitors, reversibly bind to the potassium ion receptor[10]. Through this mechanism, rapid and sustained inhibition of gastric acid secretion is facilitated. Compared to traditional PPIs, P-CABs have the advantages of a longer duration of action and stronger acid suppression [11] . When the intragastric pH exceeds 6, antibiotics generally function more effectively, thereby promoting H. pylori treatment [12] . P-CABs are now widely used in first-line H. pylori eradication therapy with good efficacy[13]. However, their efficacy in rescue therapy (continued treatment after failure of initial H. pylori eradication therapy) remains controversial. Therefore, this study aims to evaluate whether P-CABs combined with antibiotics are superior to traditional PPI-containing regimens in H. pylori rescue therapy. 2. Methods 2.1 Data Sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline [13] , a systematic review and meta-analysis were conducted by searching literature in PubMed, Web of Science, and EMBASE. PROSPERO registration number: CRD42024626863.. 2.2 Inclusion Criteria: ： Study Type: Randomized controlled trials (RCTs) or observational studies comparing the efficacy of Potassium-competitive acid blockers (P-CABs) versus Proton Pump Inhibitors (PPIs) in H. pylori eradication rescue therapy. Study Population: Only clinical trials or cohort studies involving human subjects were included; animal studies were excluded. Experimental Group: Received a P-CAB-containing rescue regimen. Control Group: Received a PPI-containing rescue regimen, with the types, doses, and duration of antibiotics being identical to the experimental group. Infection Diagnosis: Included patients must have been diagnosed with H. pylori infection before treatment by at least one of the following methods: (1) Rapid Urease Test (RUT), (2) Bacterial Culture, (3) ¹³C-Urea Breath Test (¹³C-UBT), (4) Stool H. pylori Antigen Test (SAT). Eradication Assessment: Post-treatment H. pylori eradication must be confirmed by at least one of the above methods. Outcome Measures: Studies must explicitly report eradication rates (Intention-to-Treat (ITT) or Per-Protocol (PP) analysis) and the incidence of adverse reactions. Exclusion Criteria: 1.Low-quality studies, populations not well-defined (e.g., without laboratory confirmation of H. pylori infection). 2.Studies not involving rescue therapy. 3.Animal studies. 4.Literature published only as abstracts or unpublished studies. 2.3 Study Selection and Processing: The following keywords were used to systematically search the aforementioned databases for RCTs or observational studies: Helicobacter pylori / pylori / vonoprazan / tegoprazan / Keverprazan / Linaprazan / Soraprazan / P-CABs. The search period was from database inception to December 2024. The search was limited to human studies, with no language restrictions. Two investigators independently performed literature screening based on predetermined inclusion/exclusion criteria and extracted pertinent data, which encompassed country of origin, sample size， treatment duration, therapeutic regimen, per-protocol (PP) eradication rates, and adverse event incidence. 2.4 Bias Analysis: For RCTs, the Cochrane Reviewer's Handbook tool for assessing risk of bias was used. For non-RCTs, the Newcastle-Ottawa Scale (NOS) was used. Two reviewers independently assessed the risk of bias and quality of evidence for each study, discussing and reconciling any discrepancies. 2.5 Data Processing and Analysis: Meta-analysis was performed using Review Manager 5.4.1 software, calculating and combining the risk difference (RD) and 95% confidence interval (CI) for each study. Heterogeneity among studies was assessed using Cochrane's Q test. When no statistical heterogeneity was present (p > 0.05 and I² ≤ 50%), a fixed-effects model was used for the meta-analysis. If statistical heterogeneity existed (p ≤ 0.05 or I² > 50%), a random-effects model was used. 2.6 Ethics Approval ： As this study is based on published literature, ethics committee approval and informed consent was not necessary 3. Results 3.1 Literature Search and Characteristics: The flowchart for study identification, inclusion, and exclusion is shown in Figure 1. The initial search conducted in PubMed, EMBASE, and Web of Science identified 1,373 records. Following the removal of 395 duplicates and a preliminary screening of titles and abstracts, 954 records were excluded. After a full-text review of the remaining 24 articles, 14 studies[15-28] were deemed eligible for inclusion in the meta-analysis, comprising 2 randomized controlled trials (RCTs) and 12 non-randomized studies. The characteristics of the 14 included studies (2016-2024) are summarized in Table 1. The primary antibiotics used in rescue therapy were amoxicillin and metronidazole, followed by tetracycline, clarithromycin, and sitafloxacin. Among the 14 studies, 13 compared vonoprazan with PPIs, and only 1 compared tegoprazan with PPIs. With the exception of the latter study, the treatment duration was a 7-day triple therapy (P-CAB + two antibiotics). The tegoprazan study used a 14-day bismuth-containing quadruple therapy. 3.2 Risk of Bias: The two RCTs were assessed using the Cochrane Risk of Bias tool. The remaining 12 non-RCTs were assessed using the Newcastle-Ottawa Scale (NOS), with scores ranging from 7 to 9 (see Table 2). All 14 included studies were considered to have a low risk of bias. 3.3 Efficacy of P-CAB-based Regimens: Regarding the research question of whether P-CAB-containing rescue regimens are superior to traditional PPI-containing regimens, the H. pylori eradication rate was chosen as the outcome measure. Due to low statistical heterogeneity (P=0.52, I²=0%), a fixed-effects model was used for the meta-analysis of the 14 included studies. The results showed: the combined sample size was 10,494 cases. A significant difference was observed in the PP analysis (P-CABs vs PPI: 90.2% vs 87.3%; RD=0.04, 95% CI=0.03 to 0.04), indicating that the P-CAB-containing rescue regimen is more effective than the traditional PPI regimen. As illustrated in Figure 2. 3.4 Safety Analysis: Five of the 14 included studies[15, 19, 20, 24, 28] reported safety data for P-CABs in rescue therapy (including all-grade adverse reactions). Due to low statistical heterogeneity (P=0.22, I²=30%), a fixed-effects model was used for the meta-analysis of these 5 studies. The results showed no statistically significant difference (P-CABs vs PPI: 4.6% vs 3.7%; RD=0.01, 95% CI=-0.01 to 0.02), demonstrating the absence of a statistically significant safety disparity between the two regimens. As illustrated in Figure 3. 4. Discussion P-CABs, including vonoprazan, tegoprazan, and keverprazan, are a new class of acid-suppressing drugs with clinical characteristics such as rapid onset, strong acid suppression, and long duration of action. They are widely used in the treatment of gastroesophageal reflux disease, peptic ulcers, and H. pylori eradication, and numerous studies have shown their superior efficacy over traditional PPI-based regimens in H. pylori treatment [11, 14-16] . Although P-CABs have long demonstrated superiority in first-line H. pylori eradication, some recent studies regarding rescue therapy have not shown an advantage of P-CABs combined with antibiotics over traditional PPIs [17, 18] . However, this meta-analysis, pooling data from 14 relevant studies involving 10,494 cases, demonstrates that P-CABs have a significant advantage over traditional PPIs in H. pylori rescue therapy. This conclusion differs from some previous related studies. Given the declining efficacy of first-line H. pylori therapy due to factors like antibiotic resistance [19] treatment regimens that improve the success rate of rescue therapy are of practical clinical significance. The findings of this study provide a new, more effective option for clinically treating patients who have failed initial H. pylori eradication. This study also analyzed the safety of P-CABs in H. pylori rescue therapy, concluding that there is no significant difference in safety between P-CAB-based combination regimens and traditional PPI-based combination regimens. In summary, we believe that applying P-CABs in H. pylori rescue therapy is efficient, safe, and feasible. Limitations: Due to the limited approval of P-CABs for H. pylori treatment in China and the consequent scarcity of related domestic studies, most of the literature cited in this paper is from Japan, introducing limitations in terms of population and region. Furthermore, as some studies lacked sufficient data for safety comparisons between P-CABs and PPIs in rescue therapy, The limited number of studies available for the secondary safety analysis may compromise the robustness of this conclusion. Declarations Author Contribution Author ContributionsConcept – L.T., S.; Design – L.T.; Supervision – S; Resources – L.T.; Materials – L.T., S.; Data Collection and/or Processing –L.T.; Analysis and/or Interpretation – L.T.; Literature Search – L.T., S.; Writing Manuscript – L.T.; Critical Review – S 5. Conflict of Interest: The authors declare no conflict of interest. 6.Funding Declaration: This research received no external funding. References S2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease, Z Gastroenterol 55(2) (2017) 167-206. C. Burucoa, A. Axon, Epidemiology of Helicobacter pylori infection, Helicobacter 22 Suppl 1 (2017). J.K.Y. Hooi, W.Y. Lai, W.K. Ng, M.M.Y. Suen, F.E. Underwood, D. Tanyingoh, P. Malfertheiner, D.Y. 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Tables Table 1: Characteristics of Included Studies Study Country Type Therapeutic regimen Sample Size (Events/Total) Cure Rate % (PP) Group Intervention Yamada 2016 Japan NRCT P-CABs （ 40mg VPZ+500mg MNZ+1500mg AMPC ） qd 7d 59/61 96.7 PPI （ 20mg OPZ/40mg ESO/20mg RPZ/60mg LPZ+500mg MNZ+1500mg AMPC ） qd 7d 347/374 92.7 Tsujimae 2016 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 45/51 88.2 PPI （ 20mg EPZ+250mg MNZ+750mg AMPC ） bid 7d 41/45 91.1 Ono 2017 Japan NRCT P-CABs Regimen 1: （ 20mg VPZ+200mg CLR+250mg MNZ ） bid 7d Regimen 2 （ 20mg VPZ+100mg STZ+250mg MNZ ） bid 7d 3/4 75 PPI Regimen 1: （ 10mgRPZ/30mgLPZ+200mg CLR+250mg MNZ ） bid 7d Regimen 2: （ 10mgRPZ/30mgLPZ+100mg STZ+250mg MNZ ） bid 7d 25/27 92.6 Sakurai 2017 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 73/76 96.1 PPI （ 20mg EPZ/10mgRPZ/30mgLPZ+250mg MNZ+750mg AMPC ） bid 7d 166/185 89.7 Sue 2017 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 174/211 82.5 PPI （ 20mg OPZ/20mg EPZ/10mg RPZ/30mg LPZ+250mg MNZ+750mg AMPC ） bid 7d 119/145 82.1 Nishizawa 2017 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 61/63 96.8 PPI （ 10mg RPZ/30mg LPZ+250mg MNZ+750mg AMPC ） bid 7d 479/529 90.5 Mori 2019 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 1033/1147 90.1 PPI （ 20mg OPZ/20mg ESO/10mg RPZ/30mg LPZ+250mg MNZ+750mg AMPC ） bid 7d 1776/2051 86.6 Saito 2019 Japan NRCT P-CABs 2nd-line: （ 40mg VPZ+500mg MNZ+1500mg AMPC ） qd 7d 3rd-line: （ 40mg VPZ+200mg STZ+1500mg AMPC ） qd 7d 102/114 89.5 PPI 2nd-line: （ 40mg EPZ+500mg MNZ+1500mg AMPC ） qd 7d 3rd-line: （ 40mg EPZ+200mg STZ+1500mg AMPC ） qd 7d 79/96 82.3 Sue 2019 Japan RCT P-CABs （ 20mg VPZ+100mg STZ+750mg AMPC ） bid 7d 25/30 83.3 PPI （ 20mg EPZ+100mg STZ+750mg AMPC ） bid 7d 16/28 57.1 Kusunoki 2019 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 98/108 90.7 PPI （ 20mg EPZ+100mg STZ+750mg AMPC ） bid 7d 45/49 91.8 Nabeta 2020 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 298/309 96.4 PPI （ 20mg EPZ/10mg RPZ/30mg LPZ+250mg MNZ+750mg AMPC ） bid 7d 250/274 91.2 Hojo 2020 Japan RCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 17/19 89.5 PPI （ 10mg RPZ+250mg MNZ+750mg AMPC ） bid 7d 19/22 86.4 Chan 2023 Korea NRCT P-CABs （ 50 mg TPZ ） bid+ （ 120mg BI ） qid+(500mg MNZ)tid+(500mgTC)qid 14d 70/73 95.9 PPI （ 20 mg RBZ ） bid+ （ 120mg BI ） qid+(500mg MNZ)tid+(500mgTC)qid 14d 21/22 95.5 Iwata 2024 Japan NRCT P-CABs （ 20mg VPZ+250mg MNZ+750mg AMPC ） bid 7d 1999/2232 89.6 PPI （ 20mg OPZ/20mg EPZ/10mg RPZ/30mg LPZ+250mg MNZ+750mg AMPC ） bid 7d 1851/2150 86.1 Note: VPZ, Vonoprazan; TPZ, Tegoprazan; RPZ, Rabeprazole; EPZ, Esomeprazole; OPZ, Omeprazole; LPZ, Lansoprazole; BI, Bismuth; AMPC, Amoxicillin; MNZ, Metronidazole; CLR, Clarithromycin; STZ, Sitafloxacin; TC, Tetracycline; bid, twice daily; qd, once daily. Table 2: Quality Assessment Results of Case-Control Studies Included in the Meta-Analysis Using the NOS Scale Included Study Selection Comparability Exposure/Outcome Total Score Yamada 2016 4 2 2 8 Tsujimae 2016 4 2 2 8 Ono 2017 3 2 2 7 Sakurai 2017 4 2 3 9 Sue 2017 3 2 2 7 Mori 2019 3 2 3 8 Nishizawa 2017 4 2 2 8 Saito 2019 3 2 3 8 Kusunoki 2019 4 2 3 9 Nabeta 2020 3 2 2 7 Chan 2023 3 2 2 7 Iwata 2024 4 2 2 8 Average Score 3.5 2 2.3 7.3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8054000\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":554028298,\"identity\":\"e179f1d0-404b-4808-b9c3-2ff2e7c203f8\",\"order_by\":0,\"name\":\"L. T. 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01:55:58\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":52700,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eLiterature search flowchart\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8054000/v1/72293e39560576db8c5b36f5.png\"},{\"id\":97488811,\"identity\":\"0935d9e9-a509-4c2e-b59f-c70179e1d276\",\"added_by\":\"auto\",\"created_at\":\"2025-12-05 01:55:58\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":91252,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eEfficacy comparison between P-CAB-based and PPI-based regimens in \\u003cem\\u003eH. pylori\\u003c/em\\u003e rescue therapy.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8054000/v1/642588ac9046887cd9f59517.png\"},{\"id\":97488818,\"identity\":\"9371a7ff-b519-455e-9a86-3b9232ec7be0\",\"added_by\":\"auto\",\"created_at\":\"2025-12-05 01:55:58\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":55457,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSafety comparison between P-CAB-based and PPI-based regimens in \\u003cem\\u003eH. pylori\\u003c/em\\u003e rescue therapy.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8054000/v1/3d56c9482203fb3fcc1bc904.png\"},{\"id\":103505554,\"identity\":\"7daf45d7-c7ef-4cd9-896e-01c1a51b6d63\",\"added_by\":\"auto\",\"created_at\":\"2026-02-26 13:31:45\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1785310,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8054000/v1/acbf9e5a-63e3-4c3a-b390-f80e43d03f09.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Efficacy and Safety of Potassium-Competitive Acid Blockers in Helicobacter pylori Rescue Therapy: A Meta-Analysis\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eHelicobacter pylori (H. pylori), as one of the most common pathogenic bacteria in the digestive tract, can cause various diseases such as chronic atrophic gastritis, peptic ulcers, gastric cancer, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Eradicating H. pylori can effectively improve the prognosis of these diseases\\u003csup\\u003e[1]\\u003c/sup\\u003e. Although epidemiological surveys indicate a declining trend in the incidence of \\u003cem\\u003eH. pylori\\u003c/em\\u003e in developed countries and mainland China, the prevalence remains as high as over 70% in developing countries and some impoverished regions, with a global prevalence rate of about 50%\\u003csup\\u003e[2\\u0026ndash;4]\\u003c/sup\\u003e Eradicating \\u003cem\\u003eH. pylori\\u003c/em\\u003e remains highly significant for improving the prognosis of patients with \\u003cem\\u003eH. pylori\\u003c/em\\u003e-related diseases worldwide.\\u003c/p\\u003e\\u003cp\\u003eBoth the Toronto Consensus and the Maastricht V/Florence Consensus recommend a 14-day \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication regimen containing two antibiotics, with or without bismuth, as the first-line treatment\\u003csup\\u003e[5, 6]\\u003c/sup\\u003e. However, increasing resistance rates to metronidazole, clarithromycin, and other commonly used antibiotics, coupled with factors like CYP2C19 gene polymorphism, have led to a year by year decline in the eradication rates of PPI-containing regimens\\u003csup\\u003e[7\\u0026ndash;9]\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003cp\\u003ePotassium-competitive acid blockers (P-CABs), as a new class of potent H+/K+-ATPase inhibitors, reversibly bind to the potassium ion receptor[10]. Through this mechanism, rapid and sustained inhibition of gastric acid secretion is facilitated. Compared to traditional PPIs, P-CABs have the advantages of a longer duration of action and stronger acid suppression\\u003csup\\u003e[11]\\u003c/sup\\u003e. When the intragastric pH exceeds 6, antibiotics generally function more effectively, thereby promoting \\u003cem\\u003eH. pylori\\u003c/em\\u003e treatment\\u003csup\\u003e[12]\\u003c/sup\\u003e. P-CABs are now widely used in first-line \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication therapy with good efficacy[13]. However, their efficacy in rescue therapy (continued treatment after failure of initial \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication therapy) remains controversial. Therefore, this study aims to evaluate whether P-CABs combined with antibiotics are superior to traditional PPI-containing regimens in \\u003cem\\u003eH. pylori\\u003c/em\\u003e rescue therapy.\\u003c/p\\u003e\"},{\"header\":\"2. Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e2.1 Data Sources:\\u003c/strong\\u003e Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline\\u003csup\\u003e[13]\\u003c/sup\\u003e, a systematic review and meta-analysis were conducted by searching literature in PubMed, Web of Science, and EMBASE. PROSPERO registration number: CRD42024626863..\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.2 Inclusion Criteria:\\u003c/strong\\u003e：\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStudy Type:\\u003c/strong\\u003e Randomized controlled trials (RCTs) or observational studies comparing the efficacy of Potassium-competitive acid blockers (P-CABs) versus Proton Pump Inhibitors (PPIs) in \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication rescue therapy.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStudy Population:\\u003c/strong\\u003e Only clinical trials or cohort studies involving human subjects were included; animal studies were excluded.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eExperimental\\u003c/strong\\u003e\\u003cstrong\\u003eGroup:\\u003c/strong\\u003e Received\\u0026nbsp;a P-CAB-containing rescue regimen.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eControl Group:\\u003c/strong\\u003e Received a PPI-containing rescue regimen, with the types, doses, and duration of antibiotics being identical to the experimental group.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInfection Diagnosis:\\u003c/strong\\u003e Included patients must have been diagnosed with \\u003cem\\u003eH. pylori\\u003c/em\\u003e infection before treatment by at least one of the following methods: (1) Rapid Urease Test (RUT), (2) Bacterial Culture, (3) ¹³C-Urea Breath Test (¹³C-UBT), (4) Stool \\u003cem\\u003eH. pylori\\u003c/em\\u003e Antigen Test (SAT).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEradication Assessment:\\u003c/strong\\u003e Post-treatment \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication must be confirmed by at least one of the above methods.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOutcome Measures:\\u003c/strong\\u003e Studies must explicitly report eradication rates (Intention-to-Treat (ITT) or Per-Protocol (PP) analysis) and the incidence of adverse reactions.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eExclusion Criteria:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e1.Low-quality studies, populations not well-defined (e.g., without laboratory confirmation of \\u003cem\\u003eH. pylori\\u003c/em\\u003e infection).\\u003c/p\\u003e\\n\\u003cp\\u003e2.Studies not involving rescue therapy.\\u003c/p\\u003e\\n\\u003cp\\u003e3.Animal studies.\\u003c/p\\u003e\\n\\u003cp\\u003e4.Literature published only as abstracts or unpublished studies.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.3 Study Selection and Processing:\\u003c/strong\\u003e The following keywords were used to systematically search the aforementioned databases for RCTs or observational studies: \\u003cem\\u003eHelicobacter pylori\\u003c/em\\u003e / \\u003cem\\u003epylori\\u003c/em\\u003e / vonoprazan / tegoprazan / Keverprazan / Linaprazan / Soraprazan / P-CABs. The search period was from database inception to December 2024. The search was limited to human studies, with no language restrictions.\\u003c/p\\u003e\\n\\u003cp\\u003eTwo investigators independently performed literature screening based on predetermined inclusion/exclusion criteria and extracted pertinent data, which encompassed country of origin, sample size，\\u0026nbsp;treatment duration, therapeutic regimen, per-protocol (PP) eradication rates, and adverse event incidence.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.4 Bias Analysis:\\u003c/strong\\u003e For RCTs, the Cochrane Reviewer's Handbook tool for assessing risk of bias was used. For non-RCTs, the Newcastle-Ottawa Scale (NOS) was used. Two reviewers independently assessed the risk of bias and quality of evidence for each study, discussing and reconciling any discrepancies.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.5\\u003c/strong\\u003e\\u003cstrong\\u003eData Processing and Analysis:\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMeta-analysis was performed using Review Manager 5.4.1 software, calculating and combining the risk difference (RD) and 95% confidence interval (CI) for each study. Heterogeneity among studies was assessed using Cochrane's Q test. When no statistical heterogeneity was present (p \\u0026gt; 0.05 and I² ≤ 50%), a fixed-effects model was used for the meta-analysis. If statistical heterogeneity existed (p ≤ 0.05 or I² \\u0026gt; 50%), a random-effects model was used.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.6 Ethics Approval\\u003c/strong\\u003e\\u003cstrong\\u003e：\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAs this study is based on published literature, ethics committee approval and informed consent was not necessary\\u003c/p\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e3.1 Literature Search and Characteristics:\\u003c/strong\\u003e The flowchart for study identification, inclusion, and exclusion is shown in Figure 1. The initial search conducted in PubMed, EMBASE, and Web of Science identified 1,373 records. Following the removal of 395 duplicates and a preliminary screening of titles and abstracts, 954 records were excluded. After a full-text review of the remaining 24 articles, 14 studies[15-28] were deemed eligible for inclusion in the meta-analysis, comprising 2 randomized controlled trials (RCTs) and 12 non-randomized studies.\\u003c/p\\u003e\\n\\u003cp\\u003eThe characteristics of the 14 included studies (2016-2024) are summarized in Table 1. The primary antibiotics used in rescue therapy were amoxicillin and metronidazole, followed by tetracycline, clarithromycin, and sitafloxacin. Among the 14 studies, 13 compared vonoprazan with PPIs, and only 1 compared tegoprazan with PPIs. With the exception of the latter study, the treatment duration was a 7-day triple therapy (P-CAB + two antibiotics). The tegoprazan study used a 14-day bismuth-containing quadruple therapy.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2 Risk of Bias:\\u003c/strong\\u003e The two RCTs were assessed using the Cochrane Risk of Bias tool. The remaining 12 non-RCTs were assessed using the Newcastle-Ottawa Scale (NOS), with scores ranging from 7 to 9 (see Table 2). All 14 included studies were considered to have a low risk of bias.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3 Efficacy of P-CAB-based Regimens:\\u003c/strong\\u003e Regarding the research question of whether P-CAB-containing rescue regimens are superior to traditional PPI-containing regimens, the \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication rate was chosen as the outcome measure. Due to low statistical heterogeneity (P=0.52, I\\u0026sup2;=0%), a fixed-effects model was used for the meta-analysis of the 14 included studies. The results showed: the combined sample size was 10,494 cases. A significant difference was observed in the PP analysis (P-CABs vs PPI: 90.2% vs 87.3%; RD=0.04, 95% CI=0.03 to 0.04), indicating that the P-CAB-containing rescue regimen is more effective than the traditional PPI regimen. As illustrated in Figure 2.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.4 Safety Analysis:\\u003c/strong\\u003e Five of the 14 included studies[15, 19, 20, 24, 28] reported safety data for P-CABs in rescue therapy (including all-grade adverse reactions). Due to low statistical heterogeneity (P=0.22, I\\u0026sup2;=30%), a fixed-effects model was used for the meta-analysis of these 5 studies. The results showed no statistically significant difference (P-CABs vs PPI: 4.6% vs 3.7%; RD=0.01, 95% CI=-0.01 to 0.02), demonstrating the absence of a statistically significant safety disparity between the two regimens. As illustrated in Figure 3. \\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eP-CABs, including vonoprazan, tegoprazan, and keverprazan, are a new class of acid-suppressing drugs with clinical characteristics such as rapid onset, strong acid suppression, and long duration of action. They are widely used in the treatment of gastroesophageal reflux disease, peptic ulcers, and \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication, and numerous studies have shown their superior efficacy over traditional PPI-based regimens in \\u003cem\\u003eH. pylori\\u003c/em\\u003e treatment\\u003csup\\u003e[11, 14-16]\\u003c/sup\\u003e. Although P-CABs have long demonstrated superiority in first-line \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication, some recent studies regarding rescue therapy have not shown an advantage of P-CABs combined with antibiotics over traditional PPIs\\u003csup\\u003e[17, 18]\\u003c/sup\\u003e. However, this meta-analysis, pooling data from 14 relevant studies involving 10,494 cases, demonstrates that P-CABs have a significant advantage over traditional PPIs in \\u003cem\\u003eH. pylori\\u003c/em\\u003e rescue therapy. This conclusion differs from some previous related studies. Given the declining efficacy of first-line \\u003cem\\u003eH. pylori\\u003c/em\\u003e therapy due to factors like antibiotic resistance\\u003csup\\u003e[19]\\u003c/sup\\u003e treatment regimens that improve the success rate of rescue therapy are of practical clinical significance. The findings of this study provide a new, more effective option for clinically treating patients who have failed initial \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication.\\u003c/p\\u003e\\n\\u003cp\\u003eThis study also analyzed the safety of P-CABs in \\u003cem\\u003eH. pylori\\u003c/em\\u003e rescue therapy, concluding that there is no significant difference in safety between P-CAB-based combination regimens and traditional PPI-based combination regimens. In summary, we believe that applying P-CABs in \\u003cem\\u003eH. pylori\\u003c/em\\u003e rescue therapy is efficient, safe, and feasible.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLimitations:\\u003c/strong\\u003e Due to the limited approval of P-CABs for \\u003cem\\u003eH. pylori\\u003c/em\\u003e treatment in China and the consequent scarcity of related domestic studies, most of the literature cited in this paper is from Japan, introducing limitations in terms of population and region. Furthermore, as some studies lacked sufficient data for safety comparisons between P-CABs and PPIs in rescue therapy, The limited number of studies available for the secondary safety analysis may compromise the robustness of this conclusion.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eAuthor ContributionsConcept \\u0026ndash; L.T., S.; Design \\u0026ndash; L.T.; Supervision \\u0026ndash; S; Resources \\u0026ndash; L.T.; Materials \\u0026ndash; L.T., S.; Data Collection and/or Processing \\u0026ndash;L.T.; Analysis and/or Interpretation \\u0026ndash; L.T.; Literature Search \\u0026ndash; L.T., S.; Writing Manuscript \\u0026ndash; L.T.; Critical Review \\u0026ndash; S\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e5.\\u003c/strong\\u003e\\u003cstrong\\u003eConflict of Interest:\\u003c/strong\\u003e The authors declare no conflict of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e6.Funding Declaration:\\u003c/strong\\u003eThis research received no external funding.\\u003c/p\\u003e\"},{\"header\":\" References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eS2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease, Z Gastroenterol 55(2) (2017) 167-206.\\u003c/li\\u003e\\n\\u003cli\\u003eC. Burucoa, A. Axon, Epidemiology of Helicobacter pylori infection, Helicobacter 22 Suppl 1 (2017).\\u003c/li\\u003e\\n\\u003cli\\u003eJ.K.Y. Hooi, W.Y. Lai, W.K. Ng, M.M.Y. Suen, F.E. Underwood, D. Tanyingoh, P. Malfertheiner, D.Y. Graham, V.W.S. Wong, J.C.Y. Wu, F.K.L. Chan, J.J.Y. Sung, G.G. Kaplan, S.C. Ng, Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis, Gastroenterology 153(2) (2017) 420-429.\\u003c/li\\u003e\\n\\u003cli\\u003eL. Xie, G.W. Liu, Y.N. Liu, P.Y. Li, X.N. Hu, X.Y. He, R.B. Huan, T.L. Zhao, H.J. Guo, Prevalence of Helicobacter pylori infection in China from 2014-2023: A systematic review and meta-analysis, World J Gastroenterol 30(43) (2024) 4636-4656.\\u003c/li\\u003e\\n\\u003cli\\u003eC.A. Fallone, N. Chiba, S.V. van Zanten, L. Fischbach, J.P. Gisbert, R.H. Hunt, N.L. Jones, C. Render, G.I. Leontiadis, P. Moayyedi, J.K. Marshall, The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults, Gastroenterology 151(1) (2016) 51-69.e14.\\u003c/li\\u003e\\n\\u003cli\\u003eP. Malfertheiner, F. Megraud, C.A. O\\u0026apos;Morain, J.P. Gisbert, E.J. Kuipers, A.T. Axon, F. Bazzoli, A. Gasbarrini, J. Atherton, D.Y. Graham, R. Hunt, P. Moayyedi, T. Rokkas, M. Rugge, M. Selgrad, S. Suerbaum, K. Sugano, E.M. El-Omar, Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report, Gut 66(1) (2017) 6-30.\\u003c/li\\u003e\\n\\u003cli\\u003eW. Gao, H. Cheng, F. Hu, J. Li, L. Wang, G. Yang, L. Xu, X. Zheng, The evolution of Helicobacter pylori antibiotics resistance over 10 years in Beijing, China, Helicobacter 15(5) (2010) 460-6.\\u003c/li\\u003e\\n\\u003cli\\u003eJ. Hong, X. Shu, D. Liu, Y. Zhu, C. Xie, Y. Xie, K. Zhang, A. Wang, H. Xiong, H. Zeng, H. Yu, J. Ma, Y. Chen, X. Zhu, N. Lu, Antibiotic resistance and CYP2C19 polymorphisms affect the efficacy of concomitant therapies for Helicobacter pylori infection: an open-label, randomized, single-centre clinical trial, J Antimicrob Chemother 71(8) (2016) 2280-5.\\u003c/li\\u003e\\n\\u003cli\\u003eA. Savoldi, E. Carrara, D.Y. Graham, M. Conti, E. Tacconelli, Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions, Gastroenterology 155(5) (2018) 1372-1382.e17.\\u003c/li\\u003e\\n\\u003cli\\u003eJ.M. Shin, N. Inatomi, K. Munson, D. Strugatsky, E. Tokhtaeva, O. Vagin, G. Sachs, Characterization of a novel potassium-competitive acid blocker of the gastric H,K-ATPase, 1-[5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate (TAK-438), J Pharmacol Exp Ther 339(2) (2011) 412-20.\\u003c/li\\u003e\\n\\u003cli\\u003eY. Jiang, R. Zhang, Y. Fang, R. Zhao, Y. Fu, P. Ren, Q. Zhan, M. Shao, P-CAB versus PPI in the eradication of Helicobacter pylori: a systematic review and network meta-analysis, Therap Adv Gastroenterol 17 (2024) 17562848241241223.\\u003c/li\\u003e\\n\\u003cli\\u003eR.H. Hunt, pH and Hp--gastric acid secretion and Helicobacter pylori: implications for ulcer healing and eradication of the organism, Am J Gastroenterol 88(4) (1993) 481-3.\\u003c/li\\u003e\\n\\u003cli\\u003eM.J. Page, J.E. McKenzie, P.M. Bossuyt, I. Boutron, T.C. Hoffmann, C.D. Mulrow, L. Shamseer, J.M. Tetzlaff, E.A. Akl, S.E. Brennan, R. Chou, J. Glanville, J.M. Grimshaw, A. Hr\\u0026oacute;bjartsson, M.M. Lalu, T. Li, E.W. Loder, E. Mayo-Wilson, S. McDonald, L.A. McGuinness, L.A. Stewart, J. Thomas, A.C. Tricco, V.A. Welch, P. Whiting, D. Moher, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, Bmj 372 (2021) n71.\\u003c/li\\u003e\\n\\u003cli\\u003eY. Dong, H. Xu, Z. Zhang, Z. Zhou, Q. Zhang, Comparative efficiency and safety of potassium competitive acid blockers versus Lansoprazole in peptic ulcer: a systematic review and meta-analysis, Front Pharmacol 14 (2023) 1304552.\\u003c/li\\u003e\\n\\u003cli\\u003eK. Iwakiri, Y. Fujiwara, N. Manabe, E. Ihara, S. Kuribayashi, J. Akiyama, T. Kondo, H. Yamashita, N. Ishimura, Y. Kitasako, K. Iijima, T. Koike, N. Omura, T. Nomura, O. Kawamura, S. Ohara, S. Ozawa, Y. Kinoshita, S. Mochida, N. Enomoto, T. Shimosegawa, K. Koike, Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021, J Gastroenterol 57(4) (2022) 267-285.\\u003c/li\\u003e\\n\\u003cli\\u003eJ.E. Kanu, J. Soldera, Treatment of Helicobacter pylori with potassium competitive acid blockers: A systematic review and meta-analysis, World J Gastroenterol 30(9) (2024) 1213-1223.\\u003c/li\\u003e\\n\\u003cli\\u003eB.M. Benito, O.P. Nyssen, J.P. Gisbert, Efficacy and Safety of Vonoprazan in Dual/Triple/Quadruple Regimens Both in First-Line and Rescue Therapy for Helicobacter pylori Eradication: A Systematic Review With Meta-Analysis, Helicobacter 29(6) (2024) e13148.\\u003c/li\\u003e\\n\\u003cli\\u003eH. Mori, T. Uraoka, T. Masaoka, S. Nakamuta, Y. Hirai, Y. Kubosawa, Y. Sunata, S. Banno, M. Matsushita, S. Kinoshita, Y. Nakazato, T. Nishizawa, M. Kikuchi, M. Suzuki, H. Suzuki, T. Kanai, Vonoprazan improved the efficacy of \\u0026lt;i\\u0026gt;H\\u0026lt;/i\\u0026gt;. \\u0026lt;i\\u0026gt;pylori\\u0026lt;/i\\u0026gt; eradication treatment in first-line but not in second-line regimens, Journal of Gastroenterology and Hepatology 32 (2017) 79-79.\\u003c/li\\u003e\\n\\u003cli\\u003eI. Thung, H. Aramin, V. Vavinskaya, S. Gupta, J.Y. Park, S.E. Crowe, M.A. Valasek, Review article: the global emergence of Helicobacter pylori antibiotic resistance, Aliment Pharmacol Ther 43(4) (2016) 514-33.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1:\\u003c/strong\\u003e Characteristics of Included Studies\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"612\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eStudy\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCountry\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eType\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 296px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTherapeutic regimen\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSample Size (Events/Total)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCure Rate % (PP)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGroup\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIntervention\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYamada 2016\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eJapan\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNRCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-CABs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e40mg VPZ+500mg MNZ+1500mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003eqd 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e59/61\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e96.7\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePPI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg OPZ/40mg ESO/20mg RPZ/60mg LPZ+500mg MNZ+1500mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;qd 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e347/374\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e92.7\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTsujimae 2016\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eJapan\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNRCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-CABs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg VPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e45/51\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e88.2\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePPI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg EPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e41/45\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e91.1\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOno 2017\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eJapan\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNRCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-CABs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003eRegimen 1:\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg VPZ+200mg CLR+250mg MNZ\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eRegimen 2\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg VPZ+100mg STZ+250mg MNZ\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e3/4\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e75\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePPI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003eRegimen 1:\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e10mgRPZ/30mgLPZ+200mg CLR+250mg MNZ\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eRegimen 2:\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e10mgRPZ/30mgLPZ+100mg STZ+250mg MNZ\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e25/27\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e92.6\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSakurai 2017\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eJapan\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNRCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-CABs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg VPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e73/76\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e96.1\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePPI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg EPZ/10mgRPZ/30mgLPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e166/185\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd 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style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHojo 2020\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eJapan\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-CABs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg VPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n 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TPZ\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003ebid+\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e120mg BI\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003eqid+(500mg MNZ)tid+(500mgTC)qid 14d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e70/73\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95.9\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePPI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20 mg RBZ\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003ebid+\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e120mg BI\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003eqid+(500mg MNZ)tid+(500mgTC)qid 14d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e21/22\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95.5\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 74px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIwata 2024\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 52px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eJapan\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" style=\\\"width: 41px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNRCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-CABs\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg VPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1999/2232\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e89.6\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 57px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePPI\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 240px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003e20mg OPZ/20mg EPZ/10mg RPZ/30mg LPZ+250mg MNZ+750mg AMPC\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;bid 7d\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1851/2150\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 60px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e86.1\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote: VPZ, Vonoprazan; TPZ, Tegoprazan; RPZ, Rabeprazole; EPZ, Esomeprazole; OPZ, Omeprazole; LPZ, Lansoprazole; BI, Bismuth; AMPC, Amoxicillin; MNZ, Metronidazole; CLR, Clarithromycin; STZ, Sitafloxacin; TC, Tetracycline; bid, twice daily; qd, once daily.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2:\\u003c/strong\\u003e Quality Assessment Results of Case-Control Studies Included in the Meta-Analysis Using the NOS Scale\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"562\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eIncluded Study\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSelection\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eComparability\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExposure/Outcome\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal Score\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003eYamada 2016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003eTsujimae 2016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 47px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 151px;\\\"\\u003e\\n \\u003cp\\u003eOno 2017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 140px;\\\"\\u003e\\n 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Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"P-CABs, Helicobacter pylori, Rescue Therapy, Safety\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8054000/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8054000/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eBackground: Helicobacter pylori (H. pylori) infection is associated with the development of various gastrointestinal pathologies, including gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric adenocarcinoma. Eradication of this pathogen is therefore essential for both the treatment and prevention of these conditions. Potassium-competitive acid blockers (P-CABs), a novel class of acid-suppressive agents, have been extensively incorporated into first-line H. pylori eradication regimens and have demonstrated superior efficacy compared to conventional proton pump inhibitors (PPIs). Nevertheless, their effectiveness in rescue therapy remains a subject of debate.\\u003c/p\\u003e\\n\\u003cp\\u003eObjective: To evaluate the efficacy and safety of P-CAB-containing regimens in the rescue therapy for \\u003cem\\u003eH. pylori\\u003c/em\\u003e eradication.\\u003c/p\\u003e\\n\\u003cp\\u003eMethods: Based on the PRISMA 2020 guideline（Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA 2020 Statement）, A systematic search was conducted across three electronic databases: PubMed, Web of Science, and EMBASE. The primary outcome was the eradication rate assessed by per-protocol (PP) analysis. The secondary outcome was safety. We synthesized the effect sizes using risk difference (RD) and 95% confidence interval (95% CI).\\u003c/p\\u003e\\n\\u003cp\\u003eResults: A total of 1373 references were retrieved through the search, and 14 studies (2 RCTs and 12 non-RCTs) were included, comparing P-CAB-containing rescue regimens with traditional PPI-containing rescue regimens. The PP analysis included 10,494 patients (P-CABs intervention group: 4498; PPI control group: 5996). A comparison of P-CAB- and PPI-based regimens revealed a statistically significant difference in eradication rates within the context of H. pylori rescue therapy.[RD=0.04, 95% CI=0.03 to 0.04].\\u003c/p\\u003e\\n\\u003cp\\u003eConclusion: P-CAB-based anti-\\u003cem\\u003eH. pylori\\u003c/em\\u003e regimens are more effective than PPI-based regimens in rescue therapy, with no significant difference in safety.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Efficacy and Safety of Potassium-Competitive Acid Blockers in Helicobacter pylori Rescue Therapy: A Meta-Analysis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-05 01:55:53\",\"doi\":\"10.21203/rs.3.rs-8054000/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f35f3882-3984-412f-bafc-d9c32abbbec2\",\"owner\":[],\"postedDate\":\"December 5th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-23T16:55:54+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-05 01:55:53\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8054000\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8054000\",\"identity\":\"rs-8054000\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}