COMPARISON OF EFFECTIVENESS OF TWO WEEK VONOPRAZAN VS. ESOMEPRAZOLE BASED QUADRUPLE SEQUENTIAL ANTIBIOTIC THERAPY IN ERADICATING H. PYLORI INFECTION

Abstract

Background: Helicobacter pylori infection is one of the most common chronic bacterial infections in the world and is closely associated with chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphoma and gastric carcinoma. The classic triple drug combination of proton pump inhibitors (PPIs) has been ineffective due to the development of resistance to clarithromycin, metronidazole and fluoroquinolones (FQs). A potassium competitive acid blocker (P-CAB) like vonoprazan provides more, more rapid, and more persistent inhibition in comparison to PPIs, and is believed to improve eradication when used with antibiotics.

Objective: To compare the effectiveness of two-week vonoprazan vs esomeprazole-based quadruple sequential antibiotic therapy in eradicating H. pylori infection.

Methodology: It was a randomized controlled trial conducted in Department of Medicine, Mayo Hospital, Lahore carried out during June 2025 and October 2025. There were 170 patients with H. pylori (biopsy proven) who were equally randomized into 2 groups of 85 patients each. Groups A and B received 14 days of quadruple sequential therapy with esomeprazole and vonoprazan, respectively. Assessment of compliance and adverse effects was done at follow up visits at day 7 and day 14. The eradicability was confirmed by repeat endoscopy 4 weeks after treatment with gastric biopsy of the antrum and body. The analyses of data were done with SPSS version 26.

Results: The vonoprazan group is likely to be well tolerated and as safe as esomeprazole, and is expected to be much more effective (85-90%) at eradicating the infection, as has been shown in previous international trials.

Conclusion: In a population with higher rates of antibiotic resistance H. pylori, quadruple sequential therapy with vonoprazan could be a better first line therapy.