Vonoprazan-amoxicillin dual regimen with Saccharomyces boulardii as a rescue therapy for Helicobacter pylori: Current perspectives and implications

Abstract

Yu et al’s study in the World Journal of Gastroenterology (2023) introduced a novel regimen of Vonoprazan-amoxicillin dual therapy combined with Saccharomyces boulardii (S. boulardii) for the rescue therapy against Helicobacter pylori (H. pylori), a pathogen responsible for peptic ulcers and gastric cancer. Vonoprazan is a potassium-competitive acid blocker renowned for its rapid and long-lasting acid suppression, which is minimally affected by mealtime. Compared to proton pump inhibitors, which bind irreversibly to cysteine residues in the H⁺/K⁺-ATPase pump, Vonoprazan competes with the K⁺ ions, prevents the ions from binding to the pump and blocks acid secretion. Concerns with increasing antibiotic resistance, effects on the gut microbiota, patient compliance, and side effects have led to the advent of a dual regimen for H. pylori. Previous studies suggested that S. boulardii plays a role in stabilizing the gut barrier which improves H. pylori eradication rate. With an acceptable safety profile, the dual-adjunct regimen was effective regardless of prior treatment failure and antibiotic resistance profile, thereby strengthening the applicability in clinical settings. Nonetheless, S. boulardii comes in various formulations and dosages, warranting further exploration into the optimal dosage for supplementation in rescue therapy. Additionally, larger, randomized, double-blinded controlled trials are warranted to confirm these promising results.

Keywords: Vonoprazan; Saccharomyces boulardii; Helicobacter pylori; Rescue therapy; Eradication rate

Core Tip: Vonoprazan-amoxicillin dual therapy with Saccharomyces boulardii (S. boulardii, VAS regimen) emerges as a novel rescue therapy for eradicating Helicobacter pylori (H. pylori). Vonoprazan, a potassium-competitive acid blocker, exhibits superior acid suppression compared to proton pump inhibitors. Notably, dual therapy minimizes the use of an additional antibiotic while maintaining efficacy comparable to traditional triple therapy. This paper highlights the role of S. boulardii, a probiotic, in enhancing the efficacy of Vonoprazan dual therapy by restoring gut microbiota balance, directly affecting H. pylori, and regulating immunomodulation. The VAS regimen emerges as a promising treatment alternative, demonstrating remarkable eradication of H. pylori, even in triple-resistant strains.