Analysis of oral microbiota alterations induced by Helicobacter pylori infection and vonoprazan‐amoxicillin dual therapy for Helicobacter pylori eradication

Abstract

Background The oral cavity is considered a potential reservoir of Helicobacter pylori (H. pylori), and the imbalance of oral microbiota directly reflects the health of the host. We aimed to explore the relationship among oral microbiota, H. pylori infection, and vonoprazan‐amoxicillin (VA) dual therapy for H. pylori eradication. Methods Helicobacter pylori‐positive patients were randomized into low‐ or high‐dose VA dual therapy (i.e., amoxicillin 1 g b.i.d. or t.i.d. and vonoprazan 20 mg b.i.d) for 7 or 10 days. H. pylori‐negative patients served as normal controls. Saliva samples were collected from 41 H. pylori‐positive patients and 13 H. pylori‐negative patients. The oral microbiota was analyzed by 16S rRNA gene sequencing, followed by bioinformatics analysis. Results Helicobacter pylori‐positive patients had higher richness and diversity and better evenness of oral microbiota than normal controls. Beta diversity analysis estimated by Bray–Curtis or weighted UniFrac showed distinct clustering between H. pylori‐positive patients and normal controls. The number of bacterial interactions was reduced in H. pylori‐positive patients compared with that in negative patients. Forty‐one patients evaluated before and after successful H. pylori eradication were divided into low (L‐VA) and high dose (H‐VA) amoxicillin dose groups. The alpha and beta diversity of the oral microbiota between L‐VA and H‐VA patients exhibited no differences at the three time points (before eradication, after eradication, and at confirmation of H. pylori infection cure). Conclusion Helicobacter pylori infection could alter the diversity, composition, and bacterial interactions of the oral microbiota. Both L‐VA and H‐VA dual therapy showed minimal influence on the oral microbiota.

Vonoprazan‐amoxicillin dual therapy versus bismuth‐containing quadruple therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis

“…Recently, several randomized controlled trials (RCTs) [18][19][20][21][22][23] regarding VA dual therapy versus BQT for H. pylori eradication have been published in 2023, but the results were inconsistent and controversial. Hence, we performed a systematic review and meta-analysis of RCTs to compare the effects of VA dual therapy with BQT for H. pylori eradication.…”

Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

“…The efficacy was improved (>90%) when the treatment duration was extended to 14 days. [25][26][27][28][29][30] It should be note that all the VA groups were treated with VPZ 20 mg bid and we found that high dose and low dose amoxicillin does not contribute significant difference to the cure rate. Possibly, a universally effective regimen will emerge, but it will likely require higher doses of VPZ such as 30 or 40 mg bid or tid in some regions.…”

“…As for the comparison between VA dual therapy and bismuth-containing quadruple therapy, no significant difference was observed as well. 12,25,26,28 The adverse events rate of VA dual therapy was lower than VPZ triple therapy and bismuth-containing quadruple therapy, which In contrast to the four previous systematic reviews and meta-analysis, 8,[35][36][37] our study incorporates nine articles. 12,[24][25][26][27][28]34,38 Compared with previous meta-analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual ther- This meta-analysis had several limitations that should be considered.…”

“…12,25,26,28 The adverse events rate of VA dual therapy was lower than VPZ triple therapy and bismuth-containing quadruple therapy, which In contrast to the four previous systematic reviews and meta-analysis, 8,[35][36][37] our study incorporates nine articles. 12,[24][25][26][27][28]34,38 Compared with previous meta-analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual ther- This meta-analysis had several limitations that should be considered. First, the number of studies evaluating the efficacy and safety of VPZ-containing quadruple therapy, PPIs-based dual therapy and PPIs-based triple therapy was limited (only two studies in each subgroup), which might result in ungeneralizable findings.…”

Efficacy and safety of a 14‐day modified concomitant therapy for refractory Helicobacter pylori infection: a pilot study

“…Antibiotic resistance was considered when MIC ≥1 μg/mL for clarithromycin; ≥2 μg/mL for levofloxacin, amoxicillin, tetracycline, and furazolidone; and ≥8 μg/mL for metronidazole. [17][18][19] Outcomes. The presence of H. pylori was re-assessed using a 13 C-UBT (Beijing Richen-Force Science & Technology Co. Ltd.) after 6 weeks following completion of the treatment.…”