Comparison of Vonoprazan dual therapy with Vonoprazan Bismuth-based triple therapy in Helicobacter pylori eradication – A Randomized Controlled Trial

Helicobacter pylori is a gram negative bacterium that colonizes the gastric mucosa and is a major cause of chronic gastritis peptic ulcer disease MALT lymphoma and gastric adenocarcinoma. Eradication of H pylori reduces disease related complications and is a key component of gastrointestinal disease management. However increasing antibiotic resistance poor compliance and inadequate acid suppression with proton pump inhibitors have reduced treatment success rates.

Vonoprazan is a potassium competitive acid blocker that provides rapid and sustained gastric acid suppression and is not affected by CYP2C19 genetic variability. It has shown superior or comparable efficacy to proton pump inhibitor based regimens in H pylori eradication. Vonoprazan has been approved in India in May 2024 as an adjuvant for H pylori eradication.

Although vonoprazan based dual therapy and vonoprazan based bismuth regimens have demonstrated high eradication rates direct randomized comparisons between these regimens are limited. Differences in antibiotic exposure tolerability and adherence warrant systematic evaluation.

This randomized controlled trial PILL-B Trial ( Potassium-competitive acid blocker (vonoprazan) In Low-pilL burden with Bismuth vs dual therapy)aims to compare the efficacy and safety of vonoprazan dual therapy versus vonoprazan bismuth triple therapy for eradication of H pylori infection. Secondary objectives include assessment of treatment adherence and adverse event profile.