Factors Contributing to Eradication of Helicobacter pylori With Vonoprazan, Amoxicillin Therapy

Helicobacter pylori, bacterium which causes gastric and duodenal ulcer
A team of investigators conducted a multicenter, randomized, controlled trial to identify factors related to the eradication of H pylori with dual vonoprazan and amoxicillin as first-line therapy.

Successful eradication of Helicobacter pylori using dual therapy with vonoprazan and amoxicillin (VA-dual) has been found to be associated with a smaller vs larger body size of patients. These findings were reported in a study published in Helicobacter.

Although VA-dual and vonoprazan-based triple therapy both have similar rates of H pylori eradication, factors associated with the rate of H pylori eradication using VA-dual are unknown. Therefore, a team of investigators from the Nihon University School of Medicine conducted a multicenter, randomized, controlled trial across 7 Japanese institutions to identify factors related to the eradication rate of H pylori with VA-dual as first-line therapy.

From October 2018 to June 2019, a total of 163 patients diagnosed with H pylori infection underwent VA-dual treatment (vonoprazan 20 mg twice daily and amoxicillin 750 mg twice daily for 7 days). The researchers analyzed the association between successful H pylori eradication and the following patient clinical factors: sex, age, height, weight, body surface area (BSA), body mass index (BMI), history of early gastric carcinoma and peptic ulcer, comorbidity of cirrhosis, alcohol consumption habit, smoking habit, frequency of proton pump inhibitor use, and concomitant use of drugs that are substrates of cytochrome P450 (CYP) 3A4. A retrospective analysis of the association between post-eradication adverse events and clinical factors was also conducted.

The researchers found that successful H pylori eradication was linked to a lower BSA (eradication rate: 90.8% in patients with BSA <1.723 vs 79.6% in those with BSA ≥1.723; P =.045). Participants with a BMI of <22.4 had a significantly higher eradication rate compared with those with a BMI ≥22.4 (95.6% vs 83.9%; P =.047). In addition, adverse events were reported more frequently in women than in men (adverse events: 40.0% in women vs 19.4% in men; P =.004).  

This study was limited by its retrospective design and inclusion of only Japanese individuals, which may preclude the findings from being generalizable to other populations. In addition, the effects of VA-dual on amoxicillin-resistant strains were not evaluated.

The study authors concluded, “The results indicated that the eradication rate is higher in patients with a smaller BSA or lower BMI.” They added, “Thus, VA-dual may be appropriate for patients with a small body size in first-line H. pylori treatment.”

Disclosure: One author declared affiliations with the industry. Please refer to the original article for a full list of disclosures.   


Eto H, Suzuki S, Kusano C, et al. Impact of body size on first-line Helicobacter pylori eradication success using vonoprazan and amoxicillin dual therapy. Helicobacter. Published online February 12, 2020. doi:10.1111/hel.12788