Yutaka Nagata, Kazuhiko Nagasaka, Syunpei Koyama, Mai Murase, Minoru Saito, Toshinori Yazaki, Nobutoshi Komatsu, Takayuki Murase, Toshiki Uehara, Norihide Taniuchi

Vonoprazan, a potassium-competitive acid blocker, is used as a substitute drug for conventional proton pump inhibitors. Recently, vonoprazan has been applied for eradication of H. pylori (HP) infection, and the efficacies of vonoprazan-based triple therapy against HP infection have already been reported. However, treatment sometimes fails in the primary and/or secondary triplet eradication therapy, including with the use of vonoprazan for HP infection. We experienced three cases of refractory HP infection. They were treated with eradication therapy for HP infection with chronic gastritis. After primary triplet therapy with amoxicillin, clarithromycin, and rabeprazole (Case 1) or vonoprazan (Case 2, 3), their urea breath test were positive. Subsequently, patients received secondary eradication therapy with amoxicillin, metronidazole, and vonoprazan (Case 1, 2) or rabeprazole (Case 3), but their urea breath test was still positive. Thereafter, they consulted Kampo treatment. Kampo eradication therapy was given consisting of goshuyuto 2.5 g three-times daily plus rabeprazole 10 mg twice daily for 28 days. Finally, their urea breath test became negative. We successfully treated these cases with goshuyuto and rabeprazole. Goshuyuto treatment is worth trying as another therapeutic option.