Isakov V, Goncharov A. Breaking barriers in the first-line Helicobacter pylori treatment: Chinese multicenter trial validates vonoprazan-based triple therapy. World J Gastroenterol 2025; 31(40): 112312 [DOI: 10.3748/wjg.v31.i40.112312]
Corresponding Author of This Article
Vasily Isakov, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology and Food Safety, 21 Kashirskoe Shosse, Moscow 115446, Russia. vasily.isakov@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 28, 2025; 31(40): 112312 Published online Oct 28, 2025. doi: 10.3748/wjg.v31.i40.112312
Breaking barriers in the first-line Helicobacter pylori treatment: Chinese multicenter trial validates vonoprazan-based triple therapy
Vasily Isakov, Alexei Goncharov
Vasily Isakov, Alexei Goncharov, Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow 115446, Russia
Author contributions: Isakov V designed the overall concept and outline of the manuscript; Goncharov A contributed to the discussion of the manuscript; Isakov V and Goncharov A contributed to the writing and editing the manuscript, and review of literature.
Supported by Ministry of Science and Higher Education of the Russian Federation, No. FGMF-2025-0003.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vasily Isakov, MD, PhD, Professor, Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology and Food Safety, 21 Kashirskoe Shosse, Moscow 115446, Russia. vasily.isakov@gmail.com
Received: July 23, 2025 Revised: August 25, 2025 Accepted: September 30, 2025 Published online: October 28, 2025 Processing time: 96 Days and 14.6 Hours
Abstract
The global burden of Helicobacter pylori infection continues to drive the need for effective, well-tolerated, and regionally adaptable eradication regimens. Recently Han et al presented compelling results from a multicenter randomized controlled trial in China, demonstrating the non-inferiority and potential superiority of vonoprazan (VPZ)-based triple therapy over the standard 14-day bismuth quadruple regimen. Both the 10-day and 14-day VPZ-amoxicillin-clarithromycin regimens achieved eradication rates exceeding 90% per protocol, with similar or fewer adverse events, suggesting improved patient tolerability. This study reinforces the potential of VPZ to overcome the limitations of proton pump inhibitor-based regimens, particularly in populations with CYP2C19 polymorphisms and increasing clarithromycin resistance. These findings also lend support to shortened treatment durations, which could enhance adherence and reduce antimicrobial exposure. These data highlight an important shift in the therapeutic landscape, positioning VPZ as a strong candidate for first-line empirical therapies. However, broader implementation requires careful consideration of local resistance patterns, drug accessibility, and pharmacoeconomic implications.
Core Tip: This editorial highlights a pivotal multicenter randomized controlled trial from China demonstrating that vonoprazan (VPZ)-based triple therapy achieves superior or non-inferior Helicobacter pylori eradication rates compared to standard bismuth quadruple regimens, even in high clarithromycin resistance regions. The 10-day VPZ-amoxicillin-clarithromycin regimen exceeded 90% per-protocol efficacy with fewer adverse events, offering a simplified, well-tolerated alternative aligned with global treatment goals. These findings underscore a shift in empirical first-line therapy and support the integration of VPZ into updated regional and international guidelines.
