{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:03:35Z","timestamp":1789643015649,"version":"4.0.0"},"reference-count":64,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>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\u2013Laird 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 publications were included; 12 contributed data to the comparative analysis and 9 contributed data to the non-comparative single-arm analysis, with one publication contributing to both analyses. Across the 12 comparative studies, successful eradication was achieved in 464 of 621 patients (74.7%) receiving P-CAB-based regimens and in 301 of 571 patients (52.7%) receiving PPI-based comparators. P-CAB-based regimens were associated with a significantly higher probability of successful eradication compared with PPIs (RR, 1.42; 95% CI, 1.14\u20131.76; p &lt; 0.00001). Subgroup analysis according to the P-CAB agent demonstrated that vonoprazan-based regimens exhibited the strongest comparative effect (RR, 1.78; 95% CI, 1.55\u20132.04), while tegoprazan-based regimens also remained superior (RR, 1.26; 95% CI, 1.04\u20131.54). The benefit of P-CABs was most pronounced in the clarithromycin-containing triple therapy subgroup (RR, 1.79; 95% CI, 1.55\u20132.07). Conclusions: P-CAB-based eradication regimens are significantly more effective than PPI-based comparators in patients with clarithromycin-resistant H. pylori infection. Further well-designed studies are warranted to determine the optimal antibiotic combinations, treatment durations, and regional applicability of these regimens.<\/jats:p>","DOI":"10.3390\/pathogens15090986","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:59:03Z","timestamp":1789639143000},"page":"986","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors in Eradication Regimens for Clarithromycin-Resistant Helicobacter pylori: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4007-7112","authenticated-orcid":false,"given":"Dmitrii N.","family":"Andreev","sequence":"first","affiliation":[{"name":"Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4358-7823","authenticated-orcid":false,"given":"Alsu R.","family":"Khurmatullina","sequence":"additional","affiliation":[{"name":"Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia"},{"name":"I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-3992","authenticated-orcid":false,"given":"Dmitry S.","family":"Bordin","sequence":"additional","affiliation":[{"name":"Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia"},{"name":"Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia"},{"name":"Department of General Medical Practice and Family Medicine, Tver State Medical University, 170100 Tver, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrey V.","family":"Zaborovsky","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Russian University of Medicine, 127473 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2813-6498","authenticated-orcid":false,"given":"Philipp S.","family":"Sokolov","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Russian University of Medicine, 127473 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7760-2091","authenticated-orcid":false,"given":"Yury A.","family":"Kucheryavyy","sequence":"additional","affiliation":[{"name":"Ilyinskaya Hospital, 143421 Krasnogorsk, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr A.","family":"Beliy","sequence":"additional","affiliation":[{"name":"Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor V.","family":"Maev","sequence":"additional","affiliation":[{"name":"Department of Internal Disease Propaedeutics and Gastroenterology, Russian University of Medicine, 127473 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106974","DOI":"10.1016\/j.medcli.2025.106974","article-title":"Helicobacter pylori y enfermedad g\u00e1strica","volume":"165","author":"Gisbert","year":"2025","journal-title":"Med. 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