Journal Article10.1111/HEL.12495
Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori.
Min Li,Tadayuki Oshima,Tomoki Horikawa,Katsuyuki Tozawa,Toshihiko Tomita,Hirokazu Fukui,Jiro Watari,Hiroto Miwa +7 more
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TL;DR: The ability of vonoprazan to eradicate clarithromycin‐susceptible and clarithroitcin‐resistant H. pylori strains is summarized in this meta‐analysis.
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Abstract: BACKGROUND Vonoprazan is a novel gastric acid suppressant that is applied in Japan to treat gastric diseases including Helicobacter pylori (H. pylori) infection. This meta-analysis aimed to summarize the ability of vonoprazan to eradicate clarithromycin-susceptible and clarithromycin-resistant H. pylori strains. MATERIALS AND METHODS A systematic search was performed using PubMed, EMBASE, Web of Science, and Cochrane Library. Studies were included if they evaluated eradication rates of vonoprazan-based and conventional PPI-based triple therapies and checked for clarithromycin susceptibility of H. pylori. RESULTS We identified 5 studies including a total of 1599 patients containing data regarding H. pylori with clarithromycin susceptibility. Among those infected with clarithromycin-susceptible H. pylori, eradication rates for vonoprazan-based and conventional PPI-based therapies did not significantly differ in either the randomized (RCT; pooled eradication rates, 95.4% vs 92.8%; pooled odds ratio [OR], 1.63; 95% confidence intervals [CI], 0.74-3.61; P = .225) and nonrandomized (NRCT; pooled eradication rates, 92.9% vs 86.2%; OR, 4.58; 95% CI, 0.67-31.45; P = .122) controlled trials. However, vonoprazan-based triple therapy was significantly superiority to PPI-based therapy for patients with clarithromycin-resistant strains in both RCT (pooled eradication rates, 82.0% vs 40.0%; OR, 6.83; 95% CI, 3.63-12.86; P < .0001) and NRCT (pooled eradication rates, 80.8% vs 41.8%; OR, 4.98; 95% CI, 2.47-10.03; P < .0001). CONCLUSIONS Vonoprazan-based and conventional PPI-based therapies are similarly effective for the eradication of clarithromycin-susceptible H. pylori strains. Vonoprazan is superior to conventional PPI-based therapy for the eradication of clarithromycin-resistant H. pylori strains. However, clarithromycin was misused because the combination of vonoprazan and amoxicillin cures approximately 80% of infections without clarithromycin.
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TL;DR: A 32-year-old woman who emigrated from Eastern Europe is evaluated for persistent epigastric pain and bloating and serum testing for Helicobacter pylori IgG was positive.
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Reconciliation of Recent Helicobacter pylori Treatment Guidelines in a Time of Increasing Resistance to Antibiotics.
TL;DR: The increasing resistance of H pylori to antibiotic therapy necessitates local availability of susceptibility tests for individuals, and establishment of regional and national monitoring programs to develop evidence-based locally relevant eradication strategies.
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Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the US and Europe: Randomized Clinical Trial.
TL;DR: Both vonoprazan-based regimens were superior to PPI-based triple therapy in clarithromycin-resistant strains and in the overall study population.
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Recent progress in Helicobacter pylori treatment
Yi Hu,Yin Zhu,Nonghua Lu +2 more
TL;DR: Bismuth-containing quadruple therapy has been confirmed as an effective regimen for eradicating H. pylori, especially in strains with antibiotic resistance, and high-dose proton-pump inhibitor-amoxicillin dual therapy could decrease the use of unnecessary antibiotics, which is a promising alternative approach.
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Empirical or susceptibility-guided treatment for Helicobacter pylori infection? A comprehensive review.
TL;DR: The evidence is too limited to support the generalized use of susceptibility-guided therapy for H. pylori treatment in routine clinical practice, either as first-line or as rescue treatment, and it would be recommended that susceptibility tests are performed routinely.
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