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Background: Current guidelines recommend bismuth‐containing quadruple therapy for patients newly diagnosed with Helicobacter pylori (H. pylori) infection. We aimed to compare the efficacy and safety of tetracycline administered three times daily versus four times daily in bismuth‐containing quadruple therapy for first‐line treatment of H. pylori infection. Methods: This multicenter, noninferiority, randomized controlled study, conducted in China, recruited treatment‐naïve adults with H. pylori infection, randomized 1:1 into two treatment groups to receive either of the following bismuth‐containing quadruple therapies: esomeprazole 20 mg twice‐daily; bismuth 220 mg twice‐daily; amoxicillin 1000 mg twice‐daily; and tetracycline 500 mg three times daily (TET‐T) versus 500 mg four times daily (TET‐F). At least 6 weeks post‐treatment, a 13C‐urea breath test was performed to evaluate H. pylori eradication. Results: In total, 406 patients were randomly assigned to the two treatment groups. Intention‐to‐treat eradication rates were 91.63% (186/203; 95% confidence interval [CI] 87.82%–95.44%) versus 90.15% (183/203; 95% CI 86.05%–94.25%) (p = 0.0005) and per‐protocol eradication rates were 95.34% (184/193; 95% CI 92.36%–98.31%) versus 95.72% (179/187; 95% CI 92.82%–98.62%) (p = 0.0002) for the TET‐T and TET‐F group, respectively. TET‐T‐treated patients had a lower incidence of adverse effects than TET‐F‐treated patients (21.61% vs. 31.63%, p = 0.024), with no significant differences in compliance to treatment between the groups. Conclusion: As a first‐line therapy for H. pylori infection, the eradication rate of the TET‐T therapy was noninferior to that of the TET‐F therapy while significantly reducing the incidence of adverse reactions. Trial Registration: ClinicalTrials.gov identifier: NCT05431075 [ABSTRACT FROM AUTHOR]

Objective: To investigate the management of Helicobacter pylori (H. pylori) infection by gastroenterologists from secondary and tertiary hospitals in Shandong Province, China, where there is a high prevalence of H. pylori infection. Methods: A questionnaire‐based, stratified sampling survey was conducted from June 1 to August 30, 2021. The ratio of secondary to tertiary hospitals was set at 2:1. An electronic questionnaire was sent to the gastroenterologists via the WeChat platform. Results: A total of 89.09% (1053/1182) gastroenterologists were included. Overall, 34.19% and 60.59% of gastroenterologists recommended screening for and treating H. pylori infection in patients without any competing factors. The most preferred testing method in secondary and tertiary hospitals was the 13C‐urea breath test (53.92% and 80.48%), but the reexamination rate of results close to the cut‐off value was low (55.10% and 59.48%). Gastroenterologists preferred bismuth‐containing quadruple therapy (secondary and tertiary hospitals: 96.67% and 98.53%), but the antibiotic combination prescribed for patients with penicillin allergy was suboptimal in secondary hospitals. The overall post‐treatment follow‐up rate was 64.58%, and gastroenterologists in secondary hospitals were more proactive than those in tertiary hospitals (69.41% vs 60.04%, P = 0.001). Less than 80% of gastroenterologists emphasized the importance of post‐treatment reexamination to their patients. Only a minority of gastroenterologists in secondary and tertiary hospitals (30.79% and 34.36%) achieved acceptable eradication rates (exceeding 80%). Conclusions: Deficiencies exist in gastroenterologists from secondary and tertiary hospitals, and the H. pylori eradication rate is relatively low. Training programs for gastroenterologists are warranted to strengthen their comprehension of guidelines. [ABSTRACT FROM AUTHOR]