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

ABSTRACT Introduction 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. Methods 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 I 2 . Results 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. Conclusion 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.