Vonoprazan and Helicobacter pylori Treatment: A Lesson From Japan or a Limited Geographic Phenomenon?

Abstract

Within a short time after the discovery of Helicobacter pylori , its critical role in many gastroduodenal disorders became evident. Many in vitro and in vivo data have proven that infection should be treated in order to avoid lasting colonization which may lead to problematic gastroduodenal diseases. Probiotics, preventive and therapeutic vaccines and antibiotic therapy are the main options proposed to cure these disorders. 25 years ago, triple therapy including a traditional proton pump inhibitor (PPI) and two antibiotics (amoxicillin and clarithromycin or metronidazole) was defined as the best therapy formulation for the H. pylori infection. With the strongly decreased effectiveness of this scheme, many empirical therapeutic regimens have been developed. However, the prevalence of resistance is increasing worldwide and reveals important geographic differences and even the most recent and effective regimens show some critical points. Therefore, efficacy of vonoprazan-based therapy in regions with low rate of clarithromycin resistance may be limited. In this review, we attempt to open a new window to overcome the problem of antibiotic resistance to H. pylori . In fact, we focused our attention on the possibility that conventional PPI may be replaced by vonoprazan, thus giving rise to the beginning of a new era characterized by an improved therapeutic option for H. pylori infection. Therefore, we hypothesize that switching to vonoprazan as a novel acid blocker for H. pylori treatment might allow an unexpected reassessment of the triple therapy, at least in regions with low rate of clarithromycin resistance. Nevertheless, this optimistic view of the problem could be disproved by the possible failure of vonoprazan based therapeutic regimens outside of Japan in geographic areas characterized by different rates of antibiotic resistances.

The Puzzle of Coccoid Forms of Helicobacter pylori: Beyond Basic Science

“…Moreover, it has been shown that VPZ could increase the eradication rate of triple therapy even in clarithromycin-resistant strains [94]; therefore, it is presumable that VPZ could help the transition of H. pylori from coccoid to spiral shape. However, VPZ is currently available only on the Japanese market, and other confirmatory studies are necessary to assess its potential in Western countries [95].…”

Optimizing proton pump inhibitors in Helicobacter pylori treatment: Old and new tricks to improve effectiveness

“…Another peculiarity consists in the rapid onset of the effect: While PPIs usually require more than 75-100 h to achieve the maximal gastric acid inhibitory effect[47,48], VPZ induces a fast, powerful and long-lasting gastric acid inhibition[49]. Therefore, in conclusion, VPZ seems to be better than conventional PPIs for five reasons: (1) It is more potent in acid secretion blockade; (2) It has a fast onset of action; (3) It is less prone to metabolization variables due to cytochrome polymorphisms; (4) Greater safety; and (5) Better tolerability[50].…”

“…Finally, it seems that the effectiveness of this drug could be explained by its best suppression of acid secretion. Nevertheless, these enthusiastic results require to be confirmed by forthcoming studies outside Japan[50].…”

The Potential Benefits of Vonoprazan as Helicobacter pylori Infection Therapy

“…In Indonesia, H. pylori infection prevalence is about 22.1%, suggesting H. pylori infects approximately one out of five of the population [ 5 ]. H. pylori infection is significantly correlated with incidences of gastritis, gastroesophageal reflux disease, gastroduodenal ulcers, gastric mucosal-associated lymphoid tissue (MALT) lymphoma, and gastric malignancies [ 6 , 7 , 8 , 9 ]. The eradication of H. pylori is vital in reducing peptic ulcer recurrence, in the principal therapy of gastric MALT lymphoma, and in minimizing the risk of gastric cancer [ 10 , 11 , 12 ].…”