Tu HS, Chen ML, Hong J, He L. Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: Clinical, pharmacogenetic, and microbiome perspectives. World J Gastroenterol 2026; 32(26): 116530 [DOI: 10.3748/wjg.116530]
Corresponding Author of This Article
Ling He, PhD, Chief Physician, Professor, Department of Gastroenterology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, No. 445 Bayi Avenue, Nanchang 330006, Jiangxi Province, China. heling118@126.com
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Tu HS, Chen ML, Hong J, He L. Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: Clinical, pharmacogenetic, and microbiome perspectives. World J Gastroenterol 2026; 32(26): 116530 [DOI: 10.3748/wjg.116530]
World J Gastroenterol. Jul 14, 2026; 32(26): 116530 Published online Jul 14, 2026. doi: 10.3748/wjg.116530
Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: Clinical, pharmacogenetic, and microbiome perspectives
Hou-Shu Tu, Meng-Lin Chen, Jing Hong, Ling He
Hou-Shu Tu, Meng-Lin Chen, Ling He, Department of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, Jiangxi Province, China
Jing Hong, Department of Otorhinolaryngology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China
Ling He, Department of Gastroenterology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China
Author contributions: Tu HS and He L conceived and designed the opinion review; Tu HS drafted the manuscript; Chen ML and Hong J participated in the revision of the manuscript. All authors have read and approved the final manuscript.
AI contribution statement: ChatGPT and language-editing tools were used during manuscript preparation for English language polishing, wording refinement, and improvement of readability. Some schematic figures/graphical elements were generated with the assistance of AI-based image-generation tools based on the concepts, structure, and scientific content specified by the authors. These figures are illustrative only and do not represent original experimental data, clinical images, pathological images, or independently generated scientific conclusions. The authors reviewed, revised where necessary, and approved all AI-assisted graphical outputs. The authors confirm that all scientific content, arguments, interpretations, conclusions, and final manuscript decisions were made by the authors. The authors take full responsibility for the accuracy, integrity, originality, and final content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ling He, PhD, Chief Physician, Professor, Department of Gastroenterology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, No. 445 Bayi Avenue, Nanchang 330006, Jiangxi Province, China. heling118@126.com
Received: November 14, 2025 Revised: January 7, 2026 Accepted: January 26, 2026 Published online: July 14, 2026 Processing time: 225 Days and 15.2 Hours
Abstract
Helicobacter pylori infection remains a major global health challenge, contributing to chronic gastritis, peptic ulcer disease, and gastric cancer. Rising antimicrobial resistance, host genetic variability, and inconsistent patient adherence have limited the effectiveness of conventional proton pump inhibitor-based eradication regimens. Vonoprazan-amoxicillin (VPZ-AMO) dual therapy is a promising first-line alternative, with high eradication rates, favorable tolerability, and simplified antibiotic exposure demonstrated in multicenter trials across Asia. Evidence suggests that VPZ-AMO dual therapy may outperform traditional proton pump inhibitor-based triple or bismuth quadruple therapies, particularly in populations with high clarithromycin resistance. However, important questions remain regarding its generalizability, optimal dosing, host pharmacogenetic effects, and potential long-term impacts on the gut microbiota. This opinion review summarizes current clinical evidence, highlights unresolved controversies, and outlines future research priorities, including multicenter validation, host factor-guided therapy, microbiome monitoring, and dosing optimization. By integrating these elements into a structured, sequential framework, VPZ-AMO dual therapy is presented as a safe, effective, and adaptable regimen, with substantial potential to improve Helicobacter pylori management and reduce the global burden of associated gastrointestinal diseases.
Core Tip: Vonoprazan-amoxicillin dual therapy is a potent, well-tolerated first-line regimen for Helicobacter pylori eradication, even in regions where clarithromycin resistance is prevalent. This opinion review integrates multicenter evidence, pharmacogenetics, and microbiome considerations, highlights unresolved controversies, and proposes a sequential roadmap for safe, globally applicable implementation to reduce the global burden of associated gastrointestinal diseases.
