Helicobacter pylori (H pylori) is a gram negative bacterium that colonizes the gastric mucosa and plays a central role in the pathogenesis of chronic gastritis peptic ulcer disease mucosa associated lymphoid tissue (MALT) lymphoma and gastric cancer Eradication of H pylori is critical not only for symptom relief but also for long term prevention of serious gastrointestinal complications

Traditional eradication regimens are based on proton pump inhibitor (PPI)based triple therapy which includes a PPI amoxicillin and clarithromycin However rising antibiotic resistance particularly to clarithromycin and metronidazole has reduced the efficacy of these standard therapies often dropping success rates below 80

To overcome these limitations newer agents like potassium competitive acid blockers (PCABs)notably vonoprazan have been introduced These provide stronger and more sustained acid suppression improving the gastric environment for antibiotic action Modified regimens such as vonoprazan based dual triple and quadruple therapies have demonstrated superior eradication rates particularly in resistant populations

The choice of eradication regimen depends on local antibiotic resistance patterns previous treatment history and patient specific factors such as allergies and tolerability Ongoing research is focused on optimizing treatment duration drug combinations and the use of novel acid suppressants like fexuprazan which remains under investigation