Ten vs. 14 Days of Vonoprazan-Based Therapy for Helicobacter pylori: Systematic Review and Meta-Analysis of...

Vonoprazan-based regimens achieve high Helicobacter pylori eradication rates, but the optimal duration is unclear. We performed a systematic review and meta-analysis of randomized trials comparing 10-day versus 14-day vonoprazan-based therapy.

Multiple databases were searched from inception through November 2025 for randomized controlled trials comparing 10-day and 14-day vonoprazan regimens at equal doses. The primary outcome was H. pylori eradication. Secondary outcomes included compliance and adverse events. Random-effects models pooled proportions and risk ratios (RR) with 95% confidence intervals (CIs). Heterogeneity was assessed with I².

Seven open-label trials from China (n = 3731) were included. With dual therapy, eradication was lower with 10 versus 14 days in intention-to-treat (86.6% vs. 90.6%; RR 0.96, 95% CI 0.93-0.99) and per-protocol analyses (89.3% vs. 93.4%; RR 0.95, 95% CI 0.93-0.98). With quadruple therapy, eradication did not differ (intention-to-treat: RR 1.00, 95% CI 0.96-1.03; per-protocol: RR 1.00, 95% CI 0.98-1.03). Compliance was similar between durations. Across all regimens, pooled intention-to-treat eradication modestly favored 14 days (RR 0.97, 95% CI 0.95-1.00) but was sensitive to omission of one trial. Overall adverse events did not differ (RR 0.86, 95% CI 0.71-1.04), but nausea/vomiting (RR 0.73, 95% CI 0.57-0.94) and taste disturbance (RR 0.70, 95% CI 0.50-0.98) were less frequent with 10 days.

Fourteen-day therapy provides a modest eradication benefit, most evident in dual therapy. Ten-day therapy is associated with fewer nausea/vomiting and taste disturbances. Findings are based entirely on trials from China and may not generalize elsewhere.