Seven-Day Vonoprazan-Based Triple Therapy as First-Line Helicobacter pylori Treatment in Comparison With Extended Sequential Therapy: A Randomized Controlled Trial

Comparison of Vonoprazan Triple Therapy, Bismuth Quadruple Therapy, and Amoxicillin Therapy for Helicobacter pylori Infection: A Systematic Review

Helicobacter pylori (H. pylori) infection is a significant global health concern, leading to life-threatening gastric disorders. Despite innovation in standardised treatment protocols, it faces challenges due to rising antibiotic resistance, creating the need for alternative treatments. There is a need to synthesize evidence from recent trials to enhance knowledge in critical care practice. This review synthesizes current trial data to strengthen the understanding of the literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. The literature was searched using text terms and controlled vocabulary, employing Boolean operators "AND," "OR," and various combinations across PubMed, Embase, and the Cochrane Library. Open-access, full-text English papers from 2014 to 2024 involving human-based studies were searched. The quality was assessed using Revised Cochrane Risk of Bias Tool for Randomized Trials, Version 2.0 (ROB 2.0), and the evidence was appraised using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 68 articles were retrieved through the initial search. After screening and verifying eligibility according to the pre-specified inclusion criteria, the methodological quality of 25 randomized controlled trials (RCTs) was assessed using the Cochrane Risk of Bias 2.0 tool. The GRADE tool categorised three high-ROB RCTs as "low quality." However, four RCTs had low ROB and were classified as "high quality." Eighteen RCTs had uncertain ROB, lowering the evidence by one point to "moderate quality." The study found that bismuth-quadruple therapy is an excellent first-line treatment for H. pylori infection, although its adverse effects restrict its use. Vonoprazan Triple Therapy offers a superior eradication rate with improved tolerability, making it an effective treatment option. However, high doses of amoxicillin emerge as the safest and most effective treatment, especially where clarithromycin resistance is prevalent. The management of H. pylori infection is a dynamic process. As resistance patterns evolve and new treatments are developed, it is important for healthcare providers to stay informed about emerging options. Personalized treatment, taking into account patient preferences, tolerability, and concerns about resistance, will likely continue to offer the best chance for successful eradication. Ultimately, the goal is to select the most suitable therapy for each patient, ensuring both the effectiveness and comfort of the treatment.