Vonoprazan vs. high-dose esomeprazole in bismuth-containing quadruple therapy for Helicobacter pylori rescue treatment: a retrospective cohort study.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gut Pathogens Pub Date : 2025-08-26 DOI:10.1186/s13099-025-00741-0

Xuetian Qian, Bo Gao, Zhenqiu Chen, Zhenyu Zhang, Zongdan Jiang

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Abstract

Background: The real-world comparative effectiveness study aimed to compare the effectiveness of vonoprazan (VON)-based therapy with high-dose esomeprazole (ESO)-based therapy in the re-eradication of Helicobacter pylori.

Methods: This real-world retrospective study analyzed patients at Nanjing First Hospital undergoing H. pylori re-eradication, who received either vonoprazan-based (VON) or high-dose esomeprazole-based (ESO) quadruple therapy. Both regimens included amoxicillin, furazolidone, and bismuth, administered twice daily for 14 days. Treatment strategies were determined by routine clinical practice, using either culture results or local epidemiological data. Patients were further classified into individualized precision (VON-P, ESO-P) or empirical (VON-E, ESO-E) groups based on real-world clinical decision-making.

Results: The H. pylori re-eradication rates were 89.2% (191/214, 95% CI: 84.4-92.7%) in group ESO and 86.0% (98/114, 95% CI: 78.4-91.2%) in group VON, with no statistically significant difference between groups (P = 0.381). Among patients receiving individualized precision treatment, the re-eradication rates were 87.3% (62/71, 95%CI: 77.6-93.2%) for group ESO-P and 86.9% (53/61, 95% CI: 76.2-93.2%) for group VON-P, with no significant difference observed (P = 0.940). Similarly, for patients undergoing empirical treatment, there was no statistically significant difference in re-eradication rates between group ESO-E and group VON-E (90.2%, 129/143, 95% CI: 84.2-94.1% vs. 84.9%, 45/53, 95% CI: 72.9-92.1%; P = 0.296). Additionally, no significant difference was found between group ESO-E and group ESO-P (90.2%, 129/143, 95% CI: 84.2-94.1% vs. 87.3%, 62/71, 95% CI: 77.6-93.2%; P = 0.521), nor between group VON-E and group VON-P (84.9%, 45/53, 95% CI: 72.9-92.1% vs. 86.9%, 53/61, 76.2-93.2%; P = 0.762).

Conclusions: Both high-dose esomeprazole-containing quadruple therapy and VON-containing quadruple therapy have demonstrated effective as rescue treatments for H. pylori infection. Additionally, antibiotic selection informed by local epidemiological data demonstrated comparable effective to culture-based methods in this cohort, though future large-scale studies are needed to validate its generalizability.

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伏诺哌赞与高剂量埃索美拉唑在含铋四联疗法中对幽门螺杆菌的抢救治疗：一项回顾性队列研究

背景：现实世界的比较有效性研究旨在比较以vonoprazan （VON）为基础的治疗与以大剂量埃索美拉唑（ESO）为基础的治疗在重新根除幽门螺杆菌方面的有效性。方法：本研究对南京第一医院进行幽门螺杆菌再根除手术的患者进行回顾性分析，这些患者接受了以伏诺哌赞（VON）为基础的四联治疗或以大剂量埃索美拉唑（ESO）为基础的四联治疗。两种方案均包括阿莫西林、呋喃唑酮和铋，每天两次，连续14天。治疗策略由常规临床实践确定，使用培养结果或当地流行病学数据。根据实际临床决策将患者进一步分为个体化精确组（VON-P, ESO-P）或经验组（VON-E, ESO-E）。结果：ESO组幽门螺杆菌再根除率为89.2% (191/214,95% CI: 84.4 ~ 92.7%)， VON组为86.0% (98/114,95% CI: 78.4 ~ 91.2%)，组间差异无统计学意义（P = 0.381）。在接受个体化精准治疗的患者中，ESO-P组再根除率为87.3% (62/71,95%CI: 776 -93.2%)， VON-P组再根除率为86.9% (53/61,95%CI: 76.2-93.2%)，差异无统计学意义（P = 0.940）。同样，对于经验治疗的患者，ESO-E组与VON-E组的再根除率差异无统计学意义（90.2%,129/143,95% CI: 84.2-94.1% vs. 84.9%, 45/53, 95% CI: 72.9-92.1%; P = 0.296）。此外，ESO-E组与ESO-P组间无显著性差异（90.2%,129/143,95% CI: 84.2-94.1% vs. 87.3%, 62/71, 95% CI: 77.6-93.2%, P = 0.521）， VON-E组与VON-P组间无显著性差异（84.9%,45/53,95% CI: 72.9-92.1% vs. 86.9%, 53/61, 76.2-93.2%, P = 0.762）。结论：大剂量含埃索美拉唑四联疗法和含von四联疗法均可作为幽门螺杆菌感染的抢救治疗方法。此外，在该队列中，根据当地流行病学数据进行的抗生素选择显示出与基于培养的方法相当的有效性，尽管需要未来的大规模研究来验证其普遍性。

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来源期刊

Gut Pathogens GASTROENTEROLOGY & HEPATOLOGY-MICROBIOLOGY

CiteScore

7.70

自引率

2.40%

发文量

期刊介绍： Gut Pathogens is a fast publishing, inclusive and prominent international journal which recognizes the need for a publishing platform uniquely tailored to reflect the full breadth of research in the biology and medicine of pathogens, commensals and functional microbiota of the gut. The journal publishes basic, clinical and cutting-edge research on all aspects of the above mentioned organisms including probiotic bacteria and yeasts and their products. The scope also covers the related ecology, molecular genetics, physiology and epidemiology of these microbes. The journal actively invites timely reports on the novel aspects of genomics, metagenomics, microbiota profiling and systems biology. Gut Pathogens will also consider, at the discretion of the editors, descriptive studies identifying a new genome sequence of a gut microbe or a series of related microbes (such as those obtained from new hosts, niches, settings, outbreaks and epidemics) and those obtained from single or multiple hosts at one or different time points (chronological evolution).