Vonoprazan Dual or Triple Therapy Versus Bismuth-Quadruple Therapy as First-Line Therapy for Helicobacter pylori Infection: A Three-Arm, Randomized Clinical Trial

The efficacy and safety of vonoprazan-based high-dose dual therapy for eradication of Helicobacter pylori: A systematic review and meta-analysis

In order to evaluate the effectiveness and safety of high-dose dual therapy with vonoprazan for eradicating Helicobacter pylori, we searched seven electronic databases from the establishment of the database to March 2025, collecting randomized controlled clinical trials (RCTs) comparing high-dose dual therapy with vonoprazan to high-dose dual therapy with PPI and quadruple therapy with bismuth, including 13 RCTs with 4023 patients. The primary outcome is the eradication rate determined based on intention to treat analysis and protocol analysis, while secondary outcomes include incidence of adverse events and compliance. According to ITT analysis and PP treatment analysis, the eradication rates of VA therapy were 88.81 % and 93.56 %, respectively. The incidence of adverse reactions was significantly lower (14.56 % vs 26.00 %, RR=0.57, 95 % CI: 0.48-0.67, p < 0.0001), and compliance was better (96.29 % vs 93.56 %, RR=1.03, 95 % CI: 1.01-1.05, p = 0.003), making it a reliable alternative therapy.

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.

Dual Therapies Containing an Antibiotic Plus a Proton Pump Inhibitor or Vonoprazan for Helicobacter pylori Infection: A Systematic Review

Due to the increasing prevalence of antimicrobial resistance, the efficacy of standard triple therapy for Helicobacter pylori (H. pylori) infection has declined, with eradication rates now falling below 80% in most countries. Although bismuth quadruple therapy and concomitant therapy are advised in regions with high clarithromycin resistance, these treatments commonly cause frequent adverse events and require the use of two or three antibiotics. This review article evaluates the effectiveness of 14-day mono-antibiotic therapies for H. pylori infection through randomized controlled trials conducted from 1 October 2014 to 1 October 2024. The pooled eradication rates for 14-day high-dose amoxicillin/proton pump inhibitor (PPI) dual therapies were 86.1% (3335/3875; 95% confidence interval (CI): 85.1-87.2%) by intention-to-treat (ITT) analysis and 87.3% (3232/3702; 95% CI: 86.2-88.4%) by per-protocol (PP) analysis. For 14-day high-dose amoxicillin/vonoprazan dual therapies, the rates were 87.4% (1085/1241; 95% CI: 85.5-89.2%) by ITT and 93.0% (1044/1124; 95% CI: 91.5-94.5%) by PP. In the penicillin-allergic population, 14-day tetracycline/vonoprazan dual therapy showed eradication rates of 92.0% (138/150) by ITT and 95.1% (135/142) by PP. In conclusion, 14-day tetracycline/vonoprazan dual therapy presents an effective option for eradicating H. pylori in patients allergic to penicillin. For those without a penicillin allergy, first-line treatments can include 14-day mono-antibiotic regimens, such as high-dose amoxicillin/PPI dual, high-dose amoxicillin/vonoprazan dual, and tetracycline/vonoprazan dual therapies.

Efficacy and safety of vonoprazan-amoxicillin dual therapy versus bismuth-containing quadruple therapy for patients with Helicobacter pylori infection: a meta-analysis

Introduction

This meta-analysis aims to compare the efficacy and safety of vonoprazan-amoxicillin (VA) dual therapy in comparison to bismuth-containing quadruple therapy (BQT) for patients with Helicobacter pylori (H. pylori) infection.

Materials and methods

Four databases (PubMed, Embase, Web of Science, and Cochrane Library) were searched published from establishment of database to June 1, 2024, for articles studying VA dual therapy compared to BQT for patients with H. pylori infection. Meta-analyses of eradication rates, adverse events, compliance and cost were preformed.

Results

A total of 17 studies were included for meta-analysis. Compared with BQT, VA increased the incidence of H. pylori eradication rate, with significant difference under the ITT analysis (86.9% vs. 80.4%, RR = 1.07, 95% CI: 1.01-1.12, p = 0.01) but there no significant difference under the PP analysis (90.7% vs. 86.5%, RR = 1.03, 95% CI: 0.99-1.08, p = 0.13). Besides, VA significantly increased compliance (RR = 1.03, 95% CI: 1.01-1.05, p < 0.01) and decreased the occurrence of total adverse events (27.0% vs. 11.5%, RR = 0.43, 95% CI: 0.37-0.51, p < 0.01). Furthermore, VA has lower cost compared to BQT.

Conclusion

Our findings indicated that VA dual therapy provided a higher eradication rate, enhanced compliance, decreased adverse events, and lowered cost relative to BQT for patients with H. pylori infection.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024576738, identifier CRD42024576738 (PROSPERO).

Polymicrobial interactions of Helicobacter pylori and its role in the process of oral diseases

Objective

Helicobacter pylori (H. pylori) infection affects approximately 50% of the global population. The predominant route of H. pylori transmission is through the oral pathway, making the oral cavity highly significant in its infection. This review focuses on the relationship between H. pylori and oral diseases, the influence of H. pylori infection on the oral microbiota, and the potential mechanisms involving certain oral pathogens.

Method

To identify relevant studies, we conducted searches in PubMed, Google Scholar using keywords such as "Helicobacter pylori," "oral diseases, " "oral microorganisms, " without any date restrictions. The retrieved publications were subject to a review.

Results

H. pylori infection is positively correlated with the occurrence of various oral diseases, such as dental caries, periodontitis, and oral lichen planus. H. pylori may affect the oral microbiota through various mechanisms, and there exists an interactive relationship between H. pylori and oral bacteria, including Streptococcus, Porphyromonas gingivalis (P. gingivalis), and Candida albicans (C. albicans).

Conclusions

H. pylori infection has a close relationship with certain oral diseases. H. pylori modulates oral microflora diversity and structure, while eradication therapy and medications have varying impacts on oral microbiota.