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Background: According to the Maastricht VI/Florence consensus report, potassium‐competitive acid blockers (P‐CAB) may improve Helicobacter pylori eradication treatment. Materials and methods: A total of 213 H. pylori treatment‐naive patients aged between 18 and 70 years were treated with two regimens. The two regimens are VDT: 20 mg vonoprazan twice a day and 1 g amoxicillin three times daily and EDT: 20 mg esomeprazole four times a day and 750 mg amoxicillin four times daily. 13C‐urea breath tests were used to evaluate eradication rate 4–6 weeks after treatment. Based on propensity score matching (PSM), this retrospective study analyzed the eradication rates, adverse events (AEs), compliance, and antibiotic resistance rates in VDT and EDT groups. Results: On intention‐to‐treat (ITT) analysis, the eradication rate in VDT group (89.0%; 95% CI 81.7–96.3) was non‐inferior to that in EDT group (87.7%; 95% CI 80.1–95.3; p = 0.796). The corresponding per‐protocol (PP) eradication rates were 94.1% (95% CI 88.4–99.8) and 92.8% (95% CI 86.7–98.9; p = 1.000), respectively. There were no significant between‐group differences with respect to compliance or incidence of AEs. Conclusions: The efficacy and safety of 14‐day VDT and EDT were comparable. Therefore, 14‐day VDT or EDT may be recommended for the first‐line treatment of H. pylori infection. [ABSTRACT FROM AUTHOR]

Background: Potassium‐competitive acid blockers (P‐CAB) are recommended for the treatment of Helicobacter pylori infections, but dual therapy of P‐CAB with amoxicillin has been poorly studied. The current study compared the efficacy, adverse reactions, compliance, and effects on gut microbiota of 14‐day vonoprazan‐amoxicillin (VA) dual therapy with esomeprazole, bismuth potassium citrate, amoxicillin, and metronidazole (EBAM) quadruple therapy in treatment‐naive patients with H. pylori. Materials and Methods: This was a multicenter, open‐label, randomized, and controlled, non‐inferiority study. Patients (n = 194) enrolled from six centers were randomly divided into either the VA or EBAM group. H. pylori eradication was determined using 13C urea breath tests (UBT) 4–6 weeks post‐treatment. Fecal samples were collected, and gut microbial populations were analyzed by 16S rDNA and metagenomic sequencing technology. Results: Eradication rates of H. pylori in the VA and EBAM groups were 88.7% and 91.8%, respectively, according to intention‐to‐treat (ITT) analysis; 95.6% and 96.7% with per‐protocol (PP) analysis; and 94.5% and 96.7% with modified ITT (mITT) analysis (all p > 0.05). The incidence of adverse reactions in the VA group was significantly lower compared to the EBAM group, and compliance within both groups was good. There was no difference in α‐diversity or microbial composition in the VA and EBAM groups at one‐month post‐treatment compared to baseline, except for a markedly reduced abundance of Bacteroides in the EBAM group. Conclusion: VA therapy achieved excellent eradication rates with low adverse reactions, good compliance, and little impact on gut microbiota. VA therapy should be recommended as a first‐line treatment against H. pylori. [ABSTRACT FROM AUTHOR]