Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Original Article

Volume 19, Number 3, June 2026, pages 155-164

Real-World Observational Clinical Study Assessing the Effectiveness and Safety of Vonoprazan-Based Dual Therapy Versus Proton Pump Inhibitor-Based Triple Therapy for Helicobacter pylori Eradication

↓ Figure 1. Flow diagram of patient selection and inclusion. H. pylori: Helicobacter pylori; VA: vonoprazan–amoxicillin; PAC: proton pump inhibitor–amoxicillin–clarithromycin; PPI: proton pump inhibitor; RUT: rapid urease test.

↓ Figure 2. Kaplan–Meier curve comparing PAC and VA regimens (time to symptom resolution). PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.

↓ Figure 3. Time to symptom resolution in patients treated with VA and PAC regimens. PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.

↓ Figure 4. Median cost of VA and PAC regimens. PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.

↓ **Table 1.** Patient Demographics and Baseline Characteristics
Characteristic	VA group (n = 45)	PAC group (n = 49)	P value
^aWelch’s t-test for normally distributed continuous variables and Mann–Whitney U test for skewed continuous variables. ^bPearson’s Chi-square test/Fisher’s exact test as appropriate. ^cOne observation was missing. SD: standard deviation; IQR: interquartile range; PAC: proton pump inhibitor–amoxicillin–clarithromycin; RUT: rapid urease test; VA: vonoprazan–amoxicillin.
Age, mean (SD)	38.96 (13.18)	43.49 (11.34)	0.078^a
Sex			0.306^b
Male, n (%)	25 (55.55%)	21 (42.86%)
Female, n (%)	20 (44.45%)	28 (57.14%)
Follow-up after first RUT positive date (number of days), mean (SD)	49.41^c (13.16)	70.94^c (75.23)	0.057^a
Diagnosis, n (%)			0.763^b
Chronic duodenitis	9 (20.00%)	10 (20.41%)
Chronic gastritis	24 (53.33%)	29 (59.18%)
Duodenal ulcer	8 (17.78%)	5 (10.20%)
Gastric ulcer	4 (8.89%)	5 (10.20%)
RUT result following therapy, n (%)			0.162^b
Negative	42 (93.33%)	42 (85.71%)
Positive	3 (6.67%)	7 (14.29%)
Total cost of therapy (in rupees), median (IQR)	1,020 (990–1,820)	3,380 (2,980–4,280)	< 0.001^a
Time to complete symptom resolution (days), median (IQR)	3 (3–5)	5 (5–7)	< 0.001^a
Adverse effects, number of occurrences			–
Abdominal discomfort	0	1	–
Diarrhea	4	3	–
Headache	1	1	–
Nausea	1	6	–
Taste disturbance	1	7	–
Vomiting	0	1	–
Skin rash	1	1	–
None	39	35	–

↓ Table 1. Patient Demographics and Baseline Characteristics

Characteristic

VA group (n = 45)

PAC group (n = 49)

P value

^aWelch’s t-test for normally distributed continuous variables and Mann–Whitney U test for skewed continuous variables. ^bPearson’s Chi-square test/Fisher’s exact test as appropriate. ^cOne observation was missing. SD: standard deviation; IQR: interquartile range; PAC: proton pump inhibitor–amoxicillin–clarithromycin; RUT: rapid urease test; VA: vonoprazan–amoxicillin.

Age, mean (SD)

38.96 (13.18)

43.49 (11.34)

0.078^a

Sex

0.306^b

Male, n (%)

25 (55.55%)

21 (42.86%)

Female, n (%)

20 (44.45%)

28 (57.14%)

Follow-up after first RUT positive date (number of days), mean (SD)

49.41^c (13.16)

70.94^c (75.23)

0.057^a

Diagnosis, n (%)

0.763^b

Chronic duodenitis

9 (20.00%)

10 (20.41%)

Chronic gastritis

24 (53.33%)

29 (59.18%)

Duodenal ulcer

8 (17.78%)

5 (10.20%)

Gastric ulcer

4 (8.89%)

5 (10.20%)

RUT result following therapy, n (%)

0.162^b

Negative

42 (93.33%)

42 (85.71%)

Positive

3 (6.67%)

7 (14.29%)

Total cost of therapy (in rupees), median (IQR)

1,020 (990–1,820)

3,380 (2,980–4,280)

< 0.001^a

Time to complete symptom resolution (days), median (IQR)

3 (3–5)

5 (5–7)

< 0.001^a

Adverse effects, number of occurrences

–

Abdominal discomfort

–

Diarrhea

–

Headache

–

Nausea

–

Taste disturbance

–

Vomiting

–

Skin rash

–

None

–

↓ **Table 2.** Eradication Efficacy
Outcome	VA group (n = 45)	PAC group (n = 49)	P value
^aFisher’s exact test. PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.
First-line therapy, n (%)	42/45 (93.33%)	42/49 (85.71%)	0.162^a
Second-line therapy, n (%)	1/3 (33.33%) VA→PAC switchers	7/7 (100%) PAC→VA switchers	0.002^a
Third-line therapy, n (%)	2/2 (100%) after failed rescue therapy	–	–
Subgroup analysis
Subgroup diagnosis	VA	PAC	P value
Chronic duodenitis + gastritis n (%)	33 (73.33%)	39 (79.59%)	0.63^a
Duodenal ulcer + gastric ulcer n (%)	12 (26.67%)	10 (20.41%)	0.63 ^a

↓ Table 2. Eradication Efficacy

Outcome

VA group (n = 45)

PAC group (n = 49)

P value

^aFisher’s exact test. PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.

First-line therapy, n (%)

42/45 (93.33%)

42/49 (85.71%)

0.162^a

Second-line therapy, n (%)

1/3 (33.33%) VA→PAC switchers

7/7 (100%) PAC→VA switchers

0.002^a

Third-line therapy, n (%)

2/2 (100%) after failed rescue therapy

–

Subgroup analysis

Subgroup diagnosis

PAC

P value

Chronic duodenitis + gastritis n (%)

33 (73.33%)

39 (79.59%)

0.63^a

Duodenal ulcer + gastric ulcer n (%)

12 (26.67%)

10 (20.41%)

0.63 ^a

↓ **Table 3.** Adverse Events
Adverse events, n (%)	VA group (n = 45)	PAC group (n = 49)	P value
^aFisher’s exact test. PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.
Any event	6 (13.33%)	14 (28.57%)	0.07^a
Two events	1 (2.22%)	5 (10.20%)	0.11^a
Three events	1 (2.22%)	0	–
Headache	1 (2.22%)	1 (2.04%)	1.00^a
Diarrhea	4 (8.89%)	3 (6.12%)	0.70^a
Nausea	1 (2.22%)	4 (8.16%)	0.36^a
Taste disturbance	1 (2.22%)	6 (12.24%)	0.11^a
Abdominal discomfort	0	1 (2.04%)	–
Vomiting	0	1 (2.04%)	–
Skin rash	1 (2.22%)	1 (2.04%)	1.00^a

↓ Table 3. Adverse Events

Adverse events, n (%)

VA group (n = 45)

PAC group (n = 49)

P value

^aFisher’s exact test. PAC: proton pump inhibitor–amoxicillin–clarithromycin; VA: vonoprazan–amoxicillin.

Any event

6 (13.33%)

14 (28.57%)

0.07^a

Two events

1 (2.22%)

5 (10.20%)

0.11^a

Three events

1 (2.22%)

–

Headache

1 (2.22%)

1 (2.04%)

1.00^a

Diarrhea

4 (8.89%)

3 (6.12%)

0.70^a

Nausea

1 (2.22%)

4 (8.16%)

0.36^a

Taste disturbance

1 (2.22%)

6 (12.24%)

0.11^a

Abdominal discomfort

1 (2.04%)

–

Vomiting

1 (2.04%)

–

Skin rash

1 (2.22%)

1 (2.04%)

1.00^a