Efficacy and Safety of Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors as Helicobacter Pylori Eradication Therapy

Abstract

Helicobacter pylori is a globally prevalent pathogen implicated in gastritis, peptic ulcer disease, and gastric cancer.  Objective: To compare the efficacy and safety of P-CAB-based triple therapy versus conventional PPI-based triple therapy in the eradication of H. pylori infection. Methods: This prospective, comparative study was conducted at Fauji Foundation Hospital, Rawalpindi from August 2024 to April 2025. A total of 455 patients with confirmed H. pylori infection were enrolled in the study. Patients aged between 18–75 years, a positive diagnosis of H. pylori infection confirmed through stool antigen only, and no previous eradication therapy were included in the study. Results: The eradication rate was significantly higher in Group A compared to Group B (90.8% vs. 80.6%, p = 0.003). Per-protocol analysis showed similarly superior outcomes for the P-CAB group (94.1% vs. 84.1%, p < 0.001). Both groups had comparable safety profiles, with mild adverse events reported in 13.6% of patients in Group A and 19.4% of patients in Group B (p = 0.08). Compliance rates exceeded 94% in both groups. Post-treatment symptom resolution was greater in the P-CAB group across key gastrointestinal complaints. Conclusion: It is concluded that P-CAB-based triple therapy offers significantly improved eradication rates of H. pylori compared to standard PPI-based regimens, with a favorable safety and compliance profile.