Tohoku J. Exp. Med., 2021 February, 253(2)

High Body Mass Index Is Correlated with the Success of Vonoprazan-Based Second-Line Therapy for Helicobacter Pylori Infection

Toyotaka Kasai,1 Sho Suzuki,2,3 Chika Kusano,2 Hisatomo Ikehara,2 Ryoji Ichijima,2 Motoki Ohyauchi,4 Masashi Kawamura,5 Yoshioki Yoda,6 Moriyasu Nakahara,7 Koichi Kawabe1 and Takuji Gotoda2

1Department of Gastroenterology, Fukaya Red Cross Hospital, Fukaya, Saitama, Japan
2Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
3Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjo, Akita, Japan
4Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
6Yamanashi Koseiren Health Care Center, Kofu, Yamanashi, Japan
7Department of Gastroenterology, Chichibu Municipal Hospital, Chichibu, Saitama, Japan

Eradication of Helicobacter pylori (Hp) is necessary for preventing peptic ulcers and stomach cancer. The potassium-competitive acid blocker vonoprazan is a gastric acid secretion inhibitor that improves the success rate of Hp eradication through its immediate and persistent inhibition of acid excretion. In Japan, first-line treatment involves a regimen in which vonoprazan is combined with amoxicillin and clarithromycin, while second-line treatment involves vonoprazan combined with amoxicillin and metronidazole. However, in contrast to the vonoprazan-based first-line therapy, no studies have investigated the factors influencing the success of vonoprazan-based second-line therapy. In this study, we therefore aimed to investigate factors related to the success of vonoprazan-based second-line therapy. We analyzed the association between the success of Hp eradication and patient factors including metronidazole/amoxicillin minimal inhibitory concentrations (MICs). MICs were measured using the Hp isolated from each patient. A receiver operating characteristic (ROC) analysis was conducted to examine continuous variables and eradication success. We reviewed the records of 33 patients (age: 34-79 years, male/female: 22/11, and body mass index (BMI): 16.1-28.8 kg/m2) who underwent vonoprazan-based second-line therapy after failure of first-line therapy at seven Japanese facilities between October 2018 and June 2019. The eradication success rate was 81.8% (27/33). ROC analysis revealed an area under the curve and BMI cutoff value of 0.796 and 23.8 kg/m2, respectively. The eradication success rate was higher in patients with high BMI than in those with low BMI (p = 0.007). Our findings indicate that higher BMI is correlated with the success of vonoprazan-based second-line therapy.

Keywords —— amoxicillin resistance; body mass index; eradication therapy; Helicobacter pylori infection; metronidazole resistance

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Tohoku J. Exp. Med 2021 February, 253(2), 85-94.

Correspondence: Sho Suzuki, M.D., Ph.D., Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.

e-mail: s.sho.salubriter.mail@gmail.com