Fourteen Days of Tegoprazan-Based Quadruple Therapy for H. pylori Eradication: WJG | October 2026

What Did the Study Find?

This prospective trial randomised 366 treatment-naïve adults with Helicobacter pylori infection across five South Korean centres to one of three regimens:

• Seven-day tegoprazan-based bismuth quadruple therapy.
• Fourteen-day tegoprazan-based bismuth quadruple therapy.
• Fourteen-day rabeprazole-based bismuth quadruple therapy.

The modified intention-to-treat eradication rates were 80.5%, 83.8% and 80.5%, respectively. Per-protocol rates were 81.7%, 87.5% and 79.3%.

Crucially, the 14-day tegoprazan regimen met noninferiority criteria in modified intention-to-treat and per-protocol analyses, but not in the intention-to-treat analysis. The seven-day regimen failed to establish noninferiority across the analyses. Treatment-related adverse events occurred in 19.3%, 29.7% and 26.5%, respectively; no serious treatment-related events were reported.

Why Does It Matter?

Potassium-competitive acid blockers offer rapid, potent acid suppression and may provide an alternative to proton-pump inhibitors in bismuth-based eradication regimens. Nevertheless, the modest eradication rates and failure to demonstrate noninferiority in the primary intention-to-treat comparison require caution. The results also come from a Korean population and cannot automatically be generalised to every resistance setting.

GastroAGI Takeaway: If using tegoprazan-based bismuth quadruple therapy, retain the 14-day duration; this trial does not support shortening treatment to seven days or establish definitive equivalence to standard therapy.