Comparative Analysis of Vonoprazan- and Dexlansoprazole-Based Therapies for Helicobacter pylori Eradication: A Single-Center Retrospective Observational Study

Background and aimVonoprazan, a potassium-competitive acid blocker (PCAB), has emerged as an alternative to proton pump inhibitors (PPIs) for Helicobacter pylori eradication.This study assessed the comparative effectiveness of vonoprazan-versus dexlansoprazole-based regimens in a real-world clinical setting. MethodsWe retrospectively analyzed 146 patients (73 per group) receiving vonoprazan-or dexlansoprazole-based therapy.Eradication success rates were compared using both frequency-based and Bayesian methods, with additional risk estimates and time-to-event analyses. ResultsThe vonoprazan group had a higher eradication rate (93.15%, 95% CI: 84.95, 97.04) compared with dexlansoprazole (83.56%, 95% CI: 73.43, 90.34); this difference did not reach statistical significance at the conventional 0.05 level (χ² = 3.262, p = 0.07).Risk ratio (1.11, 90% CI: 1.01, 1.23) and odds ratio (2.68, 90% CI: 1.06, 6.73) estimates using exploratory 90% CIs excluded the null at this wider, non-confirmatory threshold, favoring vonoprazan, though the corresponding 95% CIs remained inconclusive.Bayesian analysis yielded a posterior risk difference of 9.3% (95% credible interval: -1.1, 20.1) and a 96.2% posterior probability that vonoprazan was more effective, though the credible interval still included values close to and below zero.Kaplan-Meier analysis showed a shorter median time to documented confirmation of eradication with vonoprazan (97 days) than with dexlansoprazole (114 days; log-rank p = 0.02), which reflects the timing of documented testing rather than a direct measure of biological eradication speed. ConclusionsVonoprazan was associated with a numerically higher eradication rate and earlier documented confirmation of eradication compared with dexlansoprazole.While the primary comparison did not reach statistical significance at the 95% level, several exploratory analyses, including the 90% CIs and the Bayesian posterior probability, were directionally consistent with a possible advantage for vonoprazan; these findings are hypothesis-generating rather than confirmatory.Larger, multicenter, prospective studies are warranted to confirm these results.