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318 Hanno et al.ǀ Journal of Clinical and Translational Research 2024; 10(6): 317-324
1. Introduction The fast evolution of antibiotic-resistant H. pylori strains has
a significant impact on the efficacy of eradication treatment.
Helicobacter pylori, a Gram-negative, microaerobic human Antibiotic resistance is an ever-changing process, and the
pathogen, is linked to non-cardia stomach cancer, chronic active incidence of H. pylori antibiotic resistance varies greatly between
gastritis, peptic ulcer disease (PUD), atrophic gastritis, and mucosa- countries, and even in areas within the same country [10]. The
associated lymphoid tissue (MALT) lymphoma. H. pylori infects most recent agreement for H. pylori care in Egypt suggested
almost half of the adult population worldwide, though it is prevalent the same first- and second-line medications as the worldwide
across geographies, races, ages, and socioeconomic groups [1,2]. recommendations [11]; however, numerous studies recommend
Most of those infected with H. pylori will develop either identifying H. pylori antibiotic resistance.
gastric (70 – 90%) or duodenal (90%) ulcers [3]. However, Metwally et al. [12] mentioned that in Egyptian patients,
some with H. pylori infection remain asymptomatic [4]. H. pylori demonstrated more than 90% resistance to
Non-cardiac stomach cancer is the third most frequent metronidazole and amoxicillin (AMO); minor resistance to
cause of cancer deaths worldwide, with H. pylori responsible erythromycin, azithromycin, and clarithromycin (CLA); and
for 74.7% of cases. H. pylori infection remains a critical issue, low resistance to moxifloxacin and levofloxacin (≤20%). Dual
contributing to stomach cancer and ulcers, which together cause resistance was high for AMO/CLA and AMO/metronidazole,
over a million deaths worldwide annually [1]. indicating that quinolones are preferred over CLA or
Screening and treatment are needed for active H. pylori metronidazole for first-line H. pylori therapy in Egypt.
infections. Individuals with ongoing or a history of PUD (unless To enhance eradication efficiency, antibiotics have been
previously treated), low-grade MALT lymphoma, endoscopic changed, and PPI doses have been increased. The increased
excision of early gastric cancer, or individuals under 60 years rate of eradication promotes the production of potassium
old with unexplained dyspepsia and no warning symptoms competitive acid blockers (P-CABs), a chemical that decreases
should be tested for H. pylori [5]. acid output [13].
H. pylori diagnosis requires tests with >90% sensitivity Similar to PPIs, the new oral P-CAB vonoprazan inhibits
and specificity. Managing numerous gastroduodenal disorders gastric H -K -ATPase, the enzyme responsible for the final
+
+
requires accurate H. pylori diagnosis. Histological, culture, step of stomach acid production [14]. In contrast to PPIs,
and fast urease tests require endoscopy and biopsy, whereas vonoprazan inhibits the enzyme in a K -competitive and
+
serology, urea breath test, and stool antigen detection do not [1]. reversible manner [15].
A global meta-analysis found the stool antigen test (SAT) To effectively eradicate an H. pylori infection, nighttime
to be 94% sensitive and 97% specific for H. pylori infection. stomach acid suppression must be maintained over an extended
This method detected H. pylori antigen in feces. Antibiotics, period. The optimal pH range when the organism is growing
proton-pump inhibitors (PPI), N-acetylcysteine, diarrhea, and and sensitive to antibiotics (e.g., CLA and AMO) is 6 – 7 [16].
gastrointestinal (GI) bleeding can impact SAT accuracy [1]. Acid suppression achieved by currently available PPIs is often
Polyclonal antibodies and monoclonal antibodies insufficient, both in terms of magnitude and duration, to reach
are utilized in either enzyme immunoassay (EIA)- or this level throughout the entire 24-h period. However, P-CABs
immunochromatography-based SATs for H. pylori detection. are most effective when used in conjunction with one or more
The monoclonal SAT is a quick, painless, and accurate way to antimicrobial drugs, due to their unique pharmacological
determine if you have a current H. pylori infection. The EIA profile [17,18].
test, which detects anti-H. pylori IgG antibodies, is the most There is no correlation between CYP2C19 genotype and
common and effective serological test for H. pylori [1]. parietal cell activation, and P-CABs have a rapid onset of action
Serological tests are unaffected by ulcers, bleeding, stomach and a predictable anti-secretory profile. In particular, this profile
atrophy, PPIs, or antibiotics, unlike other invasive and non- has the potential to simplify complex eradication regimens
invasive investigations. Due to their low cost, speed, and patient and pave the way for the development of highly effective dual
acceptability, serological tests have been routinely employed as therapy, both of which would lead to better H. pylori treatment
a screening tool in epidemiological investigations. Even after management [18,19].
effective eradication, antibody levels in the blood can remain Furthermore, research has demonstrated that vonoprazan
elevated for extended durations, making the serological test an (pKa: 9.4) accumulates in parietal cells and that the pH of the
unreliable method of evaluation [6]. surrounding environment has little impact on its acid-inhibitory
H. pylori is an infectious disease treated with 2 – 3 antibiotics effect [20,21]. Vonoprazan administered in multiple doses
and PPI for 3 – 14 days [4]. Increasing intragastric pH with a PPI (10 – 40 mg/day) for 7 days in healthy volunteers maintained
and two antibiotics eliminates H. pylori; when the intragastric the dose-dependent, potent, and rapid acid inhibitory effects
pH exceeds 5, H. pylori can grow and become more antibiotic- observed at 24 h compared to single doses (10 – 20 mg) [22,23].
sensitive [7,8]. Vonoprazan is likely to be as effective as PPIs in H. pylori
A rise in antibiotic-resistant genotypes of H. pylori has treatment due to its stronger acid inhibition [24].
contributed to a decline in recent H. pylori eradication rates, Here, this study aimed to assess the effectiveness, safety, and
despite the continued use of conventional PPIs to inhibit gastric tolerability of vonoprazan in combination with PPI in Egyptian
acid secretion [9]. patients for the treatment of H. pylori.

DOI: http://doi.org/10.36922/jctr.24.00043