Proton pump inhibitor-based therapies remain the mainstream standard for Helicobacter pylori (H. pylori) eradication because of their lower cost and accessibility. Among these, 14-day sequential therapy (S-14) is a widely established and effective regimen with a relatively lower pill burden. Recently, 14-day vonoprazan-amoxicillin dual therapy (VA-14) has emerged as a promising alternative with similar therapeutic advantages. This study compared the efficacy and safety of VA-14 versus S-14 as first-line therapy. This single-center, prospective, randomized, non-inferiority trial enrolled 337 treatment-naïve adults. Participants were assigned to VA-14 (vonoprazan 20 mg plus amoxicillin 1000 mg twice daily for 14 days) or S-14 (lansoprazole 30 mg plus amoxicillin 1000 mg twice daily for 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 7 days). The primary endpoint was eradication rate assessed by urea breath test. Secondary outcomes included adverse events (AEs) and adherence. Intention-to-treat eradication rates were 83.9% with VA-14 and 74.0% with S-14. Per-protocol rates were 90.9% and 85.6%, respectively, demonstrating non-inferiority (P < 0.001). AEs were significantly less frequent with VA-14 (42.8% vs 78.3%, P < 0.01), including severe AEs (4.2% vs 14.3%, P < 0.01). Full adherence was higher with VA-14 (93.8% vs 90.0%, P = 0.04). Fourteen-day vonoprazan-amoxicillin dual therapy is non-inferior to sequential therapy for first-line H. pylori eradication and offers better tolerability and adherence, representing a simplified and viable low pill burden option. ClinicalTrials.gov, identifier NCT06156085.

Background/Aims: While low-quality bowel preparation is known to reduce the adenoma detection rate (ADR), the distinction between intermediate- and high-quality preparations remains unclear.Methods: Electronic searches were conducted in PubMed and Embase through July 2024. Randomized controlled trials reporting ADR and the Boston bowel preparation scale (BBPS) were included, and outcomes were pooled according to bowel preparation quality using a random-effects model. The primary outcome was ADR in intermediate-quality (BBPS ≥6, and ≥2 in each segment) versus high-quality (BBPS≥8) bowel preparation. Secondary outcomes included advanced ADR.Results: Fourteen trials were included (5,246 in the high-quality group and 1,728 in the other group). There was no significant difference in ADR (risk difference [RD], –0.02; p=0.13; I2=21%). Subgroup analyses showed no significant difference with computer-aided detection (CADe; RD, –0.03; p=0.70; I2=81%) or linked color imaging (RD, 0.04; p=0.31; I2=0%). The heterogeneity observed with CADe may reflect differences in colonoscopist experience or CADe systems. The results were similar for advanced ADR. Funnel plot and Egger’s test indicated minimal publication bias.Conclusions: Intermediate-quality preparation allows adequate adenoma detection. When each BBPS subscore is ≥2, surveillance recommendations can generally be followed.