40 years after the discovery of Helicobacter Pylori: Performing optimized "subtraction" for clinical eradication

It has been 40 years since the first discovery of the important human pathogen, Helicobacter pylori (H. pylori). Eradication of the infection continues to pose significant challenges in part because of the global increase in antibiotic resistance. Generally, the "addition" strategy has failed to deliver the desired results for more than a short period and often contributed to the increase in the prevalence of resistant strains. As such, optimization of each component of the treatment strategy has become an increasingly critical focus of research. In this study, we summarized the evolution of H. pylori eradication regimens and the emergence of promising regimens (e.g., high-dose pronto pump inhibitor dual therapy and potassium-competitive acid blocker dual therapy) in clinical practice. Moreover, we conducted an updated meta-analysis incorporating a total of 29 clinical studies regarding potassium-competitive acid blocker dual therapy. Additionally, we also conducted a network meta-analysis regarding the evaluation of first-line regimens for eradicating H. pylori among patients with penicillin allergy. We concluded that the strategy for the first-line treatment of H. pylori infection needs to shift from the traditional "addition" approach to an optimized "subtraction" approach in this era of increasing antibiotic resistance. Dual therapies, particularly those involving vonoprazan and low-dose amoxicillin, have demonstrated both satisfactory eradication rates and patient adherence.