Breaking barriers in the first-line <i>Helicobacter pylori</i> treatment: Chinese multicenter trial validates vonoprazan-based triple therapy

The global burden of <i>Helicobacter pylori</i> infection continues to drive the need for effective, well-tolerated, and regionally adaptable eradication regimens. Recently Han <i>et al</i> presented compelling results from a multicenter randomized controlled trial in China, demonstrating the non-inferiority and potential superiority of vonoprazan (VPZ)-based triple therapy over the standard 14-day bismuth quadruple regimen. Both the 10-day and 14-day VPZ-amoxicillin-clarithromycin regimens achieved eradication rates exceeding 90% per protocol, with similar or fewer adverse events, suggesting improved patient tolerability. This study reinforces the potential of VPZ to overcome the limitations of proton pump inhibitor-based regimens, particularly in populations with CYP2C19 polymorphisms and increasing clarithromycin resistance. These findings also lend support to shortened treatment durations, which could enhance adherence and reduce antimicrobial exposure. These data highlight an important shift in the therapeutic landscape, positioning VPZ as a strong candidate for first-line empirical therapies. However, broader implementation requires careful consideration of local resistance patterns, drug accessibility, and pharmacoeconomic implications.