Efficacy of Replacement of Esomeprazole by Vonoprazan with or without Bismuth Oxide on H.Pylori Eradication Rate

Document Type : Original Article

Authors

Department of Hepatology ,Gastroenterology & Infectious Diseases , Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt.

https://doi.org/10.21608/aimj.2025.446554

Abstract

Background: Helicobacter pylori (H.pylori) is a gram-negative microaerophilic bacterium that colonizes the gastric mucosa of over 50% of the global population, with a high degree of geographic variability.
Infection with H. pylori leads to in a series of histological progreeion, from chronic gastritis through atrophy, intestinal metaplasia, dysplasia, and ultimately leading to intestinal-type gastric adenocarcinoma.
Aim and objectives: To assess the efficacy of replacement of esomeprazole by vonoprazan with or without bismuth oxide on the eradication rate of H. Pylori in Egyptian cases with fixation of moxifloxacine & nitazoxanide for 2 weeks.
 Patients and methods: This prospective investigation was carried out on 160 cases presented with symptoms of H.pylori infection and confirmed the diagnosis by H.Pylori Ag in stool or Endoscopic Biopsy at Hepatology, Gastroenterology & Infectious diseases department at Bab-Elshaeria University Hospital & El Hussein University Hospital. Cases have been categorized into four groups; every group contains 40 cases.
Results: Vonoprazan groups (triple, quadriple) have more potency and longer lasting acid suppression than esomeprazole groups (triple, quadriple) which leading to more eradication rate of H-pylori and higher improvement after treatment. Adding bismuth oxide to either vonoprazan or esomeprazole leading to higher eradication rate and higher efficacy of treatment of H-pylori.
Conclusion: 1) Replacement of PPI (esomeprazole) by P-CAB (vonoprazan ) in the treatment regimen of H. pylori leads to a higher eradication rate of H-pylori and higher improvement due to the greater potency and longer-lasting acid suppression of P-CAB compared to PPI.  2)Adding bismuth oxide to the management protocol of H. pylori leads to a greater rate of eradication and more efficacy of H. pylori treatment.
 

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