Background: Helicobacter pylori (H. pylori) infection is an established risk factor for gastric cancer. However, treatment efficacy and the underlying mechanisms in elderly patients with H. pylori infection remain incompletely characterised. This study aimed to compare the eradication efficacy and safety of four amoxicillin-containing regimens for H. pylori infection in elderly patients. Methods: Elderly patients (age ≥ 60 years) with Helicobacter pylori infection treated at five hospitals in Beijing between January 2018 and June 2025 were enrolled. Participants were stratified into four groups according to the prescribed regimen: vonoprazan–amoxicillin (VA) dual therapy, rabeprazole–amoxicillin (RA) dual therapy, rabeprazole–Jinghua Weikang (a Chinese herbal medicine, granules)–amoxicillin–furazolidone (RJAF) quadruple therapy, and rabeprazole–bismuth–amoxicillin–furazolidone (RBAF) quadruple therapy. The primary endpoint was the eradication rate for each regimen. Secondary outcomes included the incidence of adverse events (AEs) and data on comorbidities. In addition, serological testing for H. pylori virulence-associated antibodies (CagA, VacA, UreA, and UreB) was performed in 32 patients at baseline, prior to treatment initiation. Results: A total of 312 patients were screened. The eradication rates with VA, RA, RJAF, and RBAF were 96.3%, 94.0%, 86.8%, and 86.6%, respectively (χ2 = 6.92, p = 0.075). The incidence of AEs was 13.8%, 15.5%, 17.9%, and 19.1% in the VA, RA, RJAF, and RBAF groups, respectively (p = 0.391). Conclusions: In elderly patients with Helicobacter pylori infection, dual therapy demonstrates non-inferior efficacy compared with triple therapy and conventional quadruple therapy. More complex regimens do not confer additional clinical benefit. Among the two dual-therapy regimens, VA dual therapy shows superior overall performance and is therefore recommended as the first-line treatment of choice.
Chen et al. (Mon,) studied this question.