What Is Helicobacter pylori?

Helicobacter pylori is a type of bacteria that causes inflammation (swelling) in the stomach. The discovery of this bacteria in the 1980s was a major scientific breakthrough, and it is now known to be connected to many stomach problems such as ulcers (sores in the stomach lining) and cancer. Helicobacter pylori is written in short form as H. pylori.

Getting rid of H. pylori will allow the stomach to heal and reduce symptoms such as pain and digestion problems. It can also lower the risk of future complications that might happen if it was left untreated.

How Can It Be Treated?

It is recommended that anyone with H. pylori takes medicine to get rid of it (and the symptoms), unless there is a medical reason not to.

The authors report that there are three things that can make treatment work the best:

1. Making sure that the natural stomach acid is controlled
2. Making sure there is enough antibiotic medicine to kill the bacteria
3. Taking medicine for a long enough time to prevent the infection coming back (up to 14 days)

It is necessary to take a combination of medicines to meet these three requirements. This is known as dual, triple, or quadruple therapy (depending on the exact number of medicine types and combinations taken—two, three, or four).

What Are the Types of Medicine Needed?

1. Medicine that controls the stomach acid. These are known as a proton pump inhibitor medicines (PPI), such as omeprazole and vonoprazan.
2. Medicine to kill the bacteria. These are known as antibiotics, such as clarithromycin or amoxicillin.

However, the more that antibiotics are used for bacterial infections (sometimes incorrectly used), the harder it can be to kill bacteria effectively. This is known as antibiotic resistance. Common treatments for H. pylori are now not working so well, because the antibiotic medicine is not as effective. This is especially the case for the antibiotic called clarithromycin, which is commonly used to treat H. pylori. The authors wanted to find out if using an alternative antibiotic or other PPI combinations might work just as well, or better.

What Alternative Medicine Did the Authors Investigate?

The authors investigated the combination of vonoprazan (a PPI) and amoxicillin (an antibiotic). This combination is known as “vonoprazan and amoxicillin dual therapy” or VA for short.

How Did the Authors Compare the Treatments?

The authors carried out what is called a systematic review and meta-analysis. They searched research databases for all research on H. pylori and the specific medicine names. There are international guidelines for how to do this in the best way: such as using special databases, using particular search words and following logical processes to carefully review and categorize what is found.

The authors found five suitable studies. These five studies included 1,852 patients in total. They used statistical methods to compare their chosen VA dual therapy with results from other medicine combinations for H. pylori, with a focus on clarithromycin combinations.

What Were the Results?

There were lots of possible combinations to compare, because the authors were comparing both the PPI and the antibiotic medicine combination possibilities. The authors used statistical methods to make the comparisons, considering many different factors about how the stomach works, what happens during an infection, and how a person’s individual health status may affect treatment.

After completing statistical calculations, the authors reported:

1. The VA combination was no worse than treatments using other antibiotics. But it was better than treatments using other PPIs.
2. For pylori infections that were resistant to clarithromycin (the commonly used antibiotic), the VA combination was better. However, the VA combination did not work better for infections without resistance.
3. The VA combination had lower side effects, especially the incidence of diarrhea.

What Does This Mean for Future Medicine Combination Options?

The authors wrote in detail about the need for a fine balance between medicine combinations and how they interact in the body. For example, the acidity of the stomach can affect how well an antibiotic works, but the acidity is also affected by the PPI medicine, so the situation is constantly changing. Ideally, a person should be tested, to know exactly what kind of H. pylori bacteria they have. A person should also be examined to determine other lifestyle or medical issues that may impact their health and the chosen treatment.

What Is the Take-Home Message?

Vonoprazan and amoxicillin dual therapy treatment can be a good option, or even the best option, for some people with H. pylori infection, but it depends on their personal health situation and their health professional’s clinical decision-making. As is often the case, the authors report that more studies should be conducted to work out the best amount of medicine to be taken, and the length of time that it should be taken for.