Efficacy analysis of a bismuth-containing quadruple therapy with vonoprazan for Helicobacter pylori infection

Objective To retrospectively analyze the efficacy and safety of a bismuth-containing quadruple regimen with vonoprazan (VPZ) in the initial eradication of Helicobacter pylori (Hp) infection and to identify influencing factors.Methods A total of 1017 treatment-naïve patients with Hp infection, who received a 14-day bismuth-containing quadruple therapy with vonoprazan (VPZ+ bismuth potassium citrate + two antibiotics) between January 2023 and December 2024 at Zhejiang Hospital, were enrolled. Based on actual antibiotic usage, patients were categorized into seven subgroups. Hp eradication rates and influencing factors were analyzed.Results The overall treatment success rate of the VPZ-based bismuth quadruple therapy was 90.9% (924/1017). The eradication rates for each subgroup were: Clarithromycin + Amoxicillin 93.3% (714/765), Furazolidone + Amoxicillin 93.5% (87/93), Clarithromycin + Furazolidone 73.7% (42/57), Levofloxacin + Cefuroxime 81.3% (39/48), Clarithromycin + Cefuroxime 100% (24/24), Levofloxacin + Clarithromycin 80.0% (12/15), and Levofloxacin + Furazolidone 40.0% (6/15). Univariate analysis revealed a statistically significant difference in eradication rates among the different treatment regimens (p = 0.002). Binary logistic regression analysis confirmed that the treatment regimen was an independent factor affecting eradication outcome (p = 0.008). Factors such as age, sex, smoking, and alcohol consumption showed no significant correlation with treatment success. All regimens demonstrated good safety profiles, with no reports of severe adverse events, and were well-tolerated, particularly among patients with comorbid gastric or duodenal ulcers.Conclusion The vonoprazan-based bismuth-containing quadruple therapy is a highly effective and safe regimen for Hp eradication, achieving a high overall success rate. It represents a preferred strategy for clinical treatment, especially for Hp-infected patients with peptic ulcers.