Vonoprazan-based therapy for Helicobacter pylori eradication: experience and clinical evidence

Abstract

Stable suppression of gastric acid secretion is a crucial factor in Helicobacter pylori eradication. Vonoprazan is a potassium-competitive acid blocker recently approved for use in Japan. As vonoprazan has a long duration of action and causes rapid and strong inhibition of gastric acid secretion, it has gained clinical attention for treating erosive oesophagitis, peptic ulcers, and H. pylori infection. In this review, we discuss the recent knowledge regarding the safety and efficacy of vonoprazan, focusing on its use in H. pylori eradication. The latest literature and our clinical experience have shown that vonoprazan-based therapies have satisfactory eradication rates. Additionally, vonoprazan-based therapies are associated with similar rates of adverse events as standard triple therapies with conventional proton-pump inhibitors.

Keywords: H. pylori; P-CAB; PPI; TAK-438; Takecab; Vonoprazan; potassium-competitive acid blocker.

Figure 1.

Simplified schematic description: differences between ‘conventional’ proton-pump inhibitors (PPIs) (a) and vonoprazan (b). (a) The H⁺/K⁺-ATPase is located on the secretary membrane of parietal cells and maintains the acidity in the stomach. The enzyme is responsible for pumping H⁺ ions out of the cells into the canaliculi, in exchange for K⁺ ions. Conventional PPIs are absorbed in the small intestine and subsequently reach the gastric parietal cells where they are converted to their active forms upon acid exposure, and covalently bind to the H⁺/K⁺-ATPase. Since conventional PPIs are unstable in canaliculi and are rapidly degraded, they are not able to inhibit new proton pumps (PPs) that surface after administration of the drug. Thus they require a few days to reach their maximum effect. (b) Vonoprazan, a potassium-competitive acid blocker, does not require acid activation. Vonoprazan is rapidly absorbed in the small intestine and accumulates in the canalicular membranes of parietal cells, binding to H⁺/K⁺-ATPase in a K⁺-competitive manner. Vonoprazan is more stable than conventional PPIs in the canaliculi, allowing fast and stable inhibition of gastric acid secretion.