Altered Gut Mycobiome After Vonoprazan-Amoxicillin Dual Therapy for Helicobacter pylori Eradication

The combination of vonoprazan and amoxicillin dual therapy has been shown to achieve acceptable eradication rates for Helicobacter pylori treatment with minimal negative effects on gut bacterial microbiota and short-chain fatty acids. However, the influence of vonoprazan dual therapy on gut mycobiome has not been adequately evaluated. Herein, we aimed to explore the short-term effect of vonoprazan dual therapy on the gut mycobiome using fungal-specific internal transcribed spacer amplicon sequencing of human fecal samples. A total of 119 H. pylori-positive patients were randomized into low- or high-dose vonoprazan and amoxicillin dual therapy (i.e., amoxicillin 1 g b.i.d. or t.i.d. and vonoprazan 20 mg b.i.d.) for 7 or 10 days. Ten H. pylori-negative patients served as controls. Fecal samples were collected from H. pylori-positive and H. pylori-negative patients and were analyzed. The gut mycobiome of H. pylori-positive patients showed increased abundance and significantly different composition compared to healthy controls. Thirty-seven patients studied before and after H. pylori eradication were divided into low and high amoxicillin dose groups. The diversity and composition of the gut mycobiome among low and high amoxicillin dose groups exhibited no differences between the pre-eradication, post-eradication, and confirmation time points. In conclusion, vonoprazan and amoxicillin dual therapy for H. pylori eradication has minimal negative effects on gut mycobiome.