Qian Xuetian, Gao Bo, Chen Zhenqiu, Zhang Zhenyu, Jiang Zongdan
Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing,Jiangsu, China.
Gut Pathog. 2025 Aug 26;17(1):68. doi: 10.1186/s13099-025-00741-0.
The real-world comparative effectiveness study aimed to compare the effectiveness of vonoprazan (VON)-based therapy with high-dose esomeprazole (ESO)-based therapy in the re-eradication of Helicobacter pylori.
This real-world retrospective study analyzed patients at Nanjing First Hospital undergoing H. pylori re-eradication, who received either vonoprazan-based (VON) or high-dose esomeprazole-based (ESO) quadruple therapy. Both regimens included amoxicillin, furazolidone, and bismuth, administered twice daily for 14 days. Treatment strategies were determined by routine clinical practice, using either culture results or local epidemiological data. Patients were further classified into individualized precision (VON-P, ESO-P) or empirical (VON-E, ESO-E) groups based on real-world clinical decision-making.
The H. pylori re-eradication rates were 89.2% (191/214, 95% CI: 84.4-92.7%) in group ESO and 86.0% (98/114, 95% CI: 78.4-91.2%) in group VON, with no statistically significant difference between groups (P = 0.381). Among patients receiving individualized precision treatment, the re-eradication rates were 87.3% (62/71, 95%CI: 77.6-93.2%) for group ESO-P and 86.9% (53/61, 95% CI: 76.2-93.2%) for group VON-P, with no significant difference observed (P = 0.940). Similarly, for patients undergoing empirical treatment, there was no statistically significant difference in re-eradication rates between group ESO-E and group VON-E (90.2%, 129/143, 95% CI: 84.2-94.1% vs. 84.9%, 45/53, 95% CI: 72.9-92.1%; P = 0.296). Additionally, no significant difference was found between group ESO-E and group ESO-P (90.2%, 129/143, 95% CI: 84.2-94.1% vs. 87.3%, 62/71, 95% CI: 77.6-93.2%; P = 0.521), nor between group VON-E and group VON-P (84.9%, 45/53, 95% CI: 72.9-92.1% vs. 86.9%, 53/61, 76.2-93.2%; P = 0.762).
Both high-dose esomeprazole-containing quadruple therapy and VON-containing quadruple therapy have demonstrated effective as rescue treatments for H. pylori infection. Additionally, antibiotic selection informed by local epidemiological data demonstrated comparable effective to culture-based methods in this cohort, though future large-scale studies are needed to validate its generalizability.
这项真实世界的比较有效性研究旨在比较基于沃克帕唑（VON）的疗法与基于高剂量埃索美拉唑（ESO）的疗法在幽门螺杆菌再根除治疗中的有效性。
这项真实世界的回顾性研究分析了南京医科大学第一附属医院接受幽门螺杆菌再根除治疗的患者，他们接受了基于沃克帕唑（VON）或基于高剂量埃索美拉唑（ESO）的四联疗法。两种方案均包括阿莫西林、呋喃唑酮和铋剂，每天服用两次，持续14天。治疗策略由常规临床实践根据培养结果或当地流行病学数据确定。根据真实世界的临床决策，患者进一步分为个体化精准治疗组（VON-P，ESO-P）或经验性治疗组（VON-E，ESO-E）。
ESO组的幽门螺杆菌再根除率为89.2%（191/214，95%CI：84.4-92.7%），VON组为86.0%（98/114，95%CI：78.4-91.2%），两组之间无统计学显著差异（P = 0.381）。在接受个体化精准治疗的患者中，ESO-P组的再根除率为87.3%（62/71，95%CI：77.6-93.2%），VON-P组为86.9%（53/61，95%CI：76.2-93.2%），未观察到显著差异（P = 0.940）。同样，对于接受经验性治疗的患者，ESO-E组和VON-E组的再根除率也无统计学显著差异（90.2%，129/143，95%CI：84.2-94.1%对84.9%，45/53，95%CI：72.9-92.1%；P = 0.296）。此外，ESO-E组和ESO-P组之间未发现显著差异（90.2%，129/143，95%CI：84.2-94.1%对87.3%，62/71，95%CI：77.6-93.2%；P = 0.521），VON-E组和VON-P组之间也未发现显著差异（84.9%，45/53，95%CI：72.9-92.1%对86.9%，53/61，76.2-93.2%；P = 0.762）。
含高剂量埃索美拉唑的四联疗法和含VON的四联疗法均已证明对幽门螺杆菌感染的挽救治疗有效。此外，根据当地流行病学数据选择抗生素在该队列中显示出与基于培养的方法相当的有效性，不过未来需要大规模研究来验证其普遍性。
