The Ideal <b><i>Helicobacter pylori</i></b> Treatment for the Present and the Future

Abstract

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; &lt;i&gt;Helicobacter pylori&lt;/i&gt; eradication treatments are widely performed to improve gastric mucosal inflammation, promote ulcer healing, and reduce the incidence of gastric cancer. However, there are several issues associated with &lt;i&gt;H. pylori&lt;/i&gt; eradication treatment. First, various treatment regimens are currently used worldwide, and the standard treatment varies with region and country. Second, the antimicrobial resistance of &lt;i&gt;H. pylori&lt;/i&gt; is increasing due to indiscriminate antibiotic use. Finally, gut microbiota dysbiosis is potentially induced by &lt;i&gt;H. pylori&lt;/i&gt; treatment. &lt;b&gt;&lt;i&gt;Summary:&lt;/i&gt;&lt;/b&gt; Based on current international guidelines and a network meta-analysis comparing the effects of various treatment regimens, nonbismuth quadruple therapies for 10–14 days and vonoprazan-based triple therapy for 7 days are the currently recommended &lt;i&gt;H. pylori&lt;/i&gt; treatment regimens. These regimens show good eradication rates of approximately 90%, even in areas where antimicrobial-resistant strains are highly prevalent. However, these regimens still have inherent drawbacks that may promote further increases in antimicrobial resistance and induce gut microbiota dysbiosis because of the empiric use of multiple antibiotics. &lt;b&gt;&lt;i&gt;Key Message:&lt;/i&gt;&lt;/b&gt; The ideal concept for the present and future &lt;i&gt;H. pylori&lt;/i&gt; eradication treatment involves “a simple, cost-effective strategy that fosters compliance without having a negative impact on the gut microbiota or contributing to future antimicrobial resistance.” One interesting possibility that may fulfill this concept is a dual therapy involving vonoprazan and amoxicillin. This is the simplest treatment regimen that provides acceptable eradication rates, improves safety and tolerability, and minimizes the potential for increasing antimicrobial resistance or causing gut microbiota dysbiosis.

The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis

“…The use of clarithromycin can drive antibiotic resistance at the population level [53] and would not be effective for the treatment of clarithromycin-resistant infections [54]. Therefore, Suzuki et al suggested the use of vonoprazan dual therapy because it may provide comparable eradication rates, improve safety and tolerability, and minimize antimicrobial resistance [55]. Moreover, ACG guidelines recommend avoiding clarithromycin in locations where the resistance rate to clarithromycin is greater than 15% [9].…”

Establishment and Methodological Evaluation of a Method for Rapid Detection of Helicobacter pylori and Virulence Genes Based on CRISPR-Cas12a

“… 20 There is evidence that timely diagnosis and eradication of H. pylori can improve gastric mucosal inflammation, promote ulcer healing, and reduce the incidence of gastric cancer. 21 The virulence of the strain plays an important role in the clinical consequences of a H. pylori infection. 22 H. pylori has two important toxins, cagA and vacA , which are the main pathogenic factors of the organism.…”

Clinical Effect, Analysis of Amoxicillin Clavulanate Potassium Combined with Shenling Baizhu Powder in the Treatment of Gastric Ulcer with Helicobacter pylori Infection

“…Myeloperoxidase is a marker of neutrophil infiltration during inflammation. There is one clinical study, shown that oral herbal compounds for 1 mo can remarkably increase mucosal Mucin5AC (MUC5AC) (human mucin gene) levels in gastric ulcer patients [17] .…”