Successful treatment of refractory Helicobacter pylori infection with a potassium-competitive acid blocker-based regimen: A case report

Helicobacter pylori is a microorganism associated with dyspepsia, peptic ulcer disease, and gastric adenocarcinoma. We report the case of a 67-year-old female who presented with dyspepsia and was found to have refractory H. pylori infection despite multiple treatment regimens. Repeat endoscopy with biopsy revealed persistent H. pylori-associated gastritis with focal intestinal metaplasia. Antibiotic susceptibility testing demonstrated sensitivity to most antibiotics except metronidazole. The patient was treated with a salvage regimen consisting of vonoprazan, a potassium-competitive acid blocker (PCAB), and amoxicillin, which successfully eradicated the infection. The failure of prior regimens was likely due to inadequate acid suppression, which may be linked to the metabolism of first-generation proton pump inhibitors (PPIs). This case highlights the potential of PCAB-based therapy in refractory H. pylori infections and emphasizes the importance of acid suppression for successful eradication.