Eficacia de la terapia dual con amoxicilina y vonoprazan versus la terapia cuádruple con bismuto para la erradicación de helicobacter pylori: una revisión sistemática

Abstract

Objective: To determine the efficacy and safety of dual therapy with amoxicillin and vonoprazan versus bismuth-based quadruple therapy to eradicate Helicobacter pylori. Methodology: A systematic literature review was conducted using significant databases such as (Medline, Embase, MDPI, Cochrane, LILACS) and keywords (Helicobacter pylori, vonoprazan, amoxicillin, and bismuth, among others). Eleven studies meeting eligibility criteria were selected (inclusion: studies with dual therapy using amoxicillin and vonoprazan in one treatment arm and bismuth-based quadruple therapy in the other; exclusion: abstracts, conference presentations, other article types, and quadruple therapy including vonoprazan). Efficacy, safety, and quality were assessed using the NIH risk of bias tool for clinical studies. Results: Eleven articles were included, all randomized non-inferiority clinical trials with 100 to 600 participants suffering from untreated H. pylori gastric infection. The eradication efficacy of H. pylori with dual therapy using vonoprazan and amoxicillin ranged from 59.3% to 98.5%. H. pylori eradication rates were similar between the two therapies (OR 1.27, 95% CI 0.72–2.22, p=0.41), as most included studies were non-inferiority trials. Reported adverse events were gastrointestinal, with dual therapy showing a lower incidence (OR 0.28, 95% CI 0.23–0.35, p=<0.00001) than bismuth-based quadruple therapy. Both groups demonstrated high adherence rates of over 80%. Keywords: vonoprazan, eradication, Helicobacter pylori, amoxicillin, bismuth