Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: Clinical, pharmacogenetic, and microbiome perspectives

Figure 1 Sequential roadmap for vonoprazan-amoxicillin dual therapy research. This figure presents a horizontal, stepwise framework for future research on vonoprazan-amoxicillin dual therapy. The roadmap consists of five consecutive modules: (1) Multicenter validation, confirming efficacy across geographic regions and populations; (2) Host factor-guided therapy, integrating pharmacogenetic profiling, age, and comorbidity to tailor dosing; (3) Microbiome monitoring, tracking gut microbial diversity, short-chain fatty acids, and resistome dynamics; (4) Dosing optimization, adjusting dose, duration, and combination strategies for maximal efficacy and safety; and (5) Implementation research, evaluating cost-effectiveness, adherence, and policy considerations. Arrows indicate sequential progression from validation to implementation. This schematic integrates author perspectives and highlights critical steps to translate regional clinical findings into globally effective first-line Helicobacter pylori eradication strategies. VPZ-AMO: Vonoprazan-amoxicillin; SCFA: Short-chain fatty acid.