A Novel Approach to H. pylori Eradication: A Narrative Review of Vonoprazan-Based Therapies

Helicobacter pylori is a primary cause of several gastrointestinal diseases, including chronic gastritis and gastric cancer. Unfortunately, standard treatments are increasingly failing due to rising antimicrobial resistance, particularly to clarithromycin. This necessitates the development of optimized H. pylori management strategies that minimize antibiotic use, reduce adverse effects, lower costs, and improve compliance. Vonoprazan-based regimens seem to be a viable option, as vonoprazan (VPZ) offers more consistent and potent acid suppression because it is not significantly affected by CYP2C19 genetic variations. This review comprehensively analyzed 43 clinical studies from the past five years in PubMed, evaluating the efficacy and safety of vonoprazan-based regimens for H. pylori eradication, including comparisons with established and novel therapies of varying doses and durations. The findings consistently demonstrate that VPZ-based therapies achieve comparable or superior eradication rates, alongside a more favorable safety profile and enhanced cost-effectiveness. While high-dose vonoprazan-amoxicillin (VA) therapy temporarily impacts gut microbiota and can persistently affect the antibiotic resistome, low-dose VA regimens show negligible effects. This highlights VA therapy as a promising candidate for an optimal H. pylori eradication strategy, though further long-term research, particularly in diverse global populations, is essential to definitively establish the best possible regimens.