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Background: Vonoprazan, a potassium‐competitive acid blocker, has demonstrated greater potency and a longer duration of acid suppression when compared to the proton pump inhibitors. However, data regarding the comparison between vonoprazan‐based triple therapy with standard treatment for first‐line Helicobacter pylori treatment are limited. This study aimed to compare the efficacy between 7‐day vonoprazan‐based triple therapy with high‐dose amoxicillin (VAC‐7) and 14‐day extended sequential therapy (S‐14). Materials and Methods: This was a single‐center prospective randomized controlled trial following a noninferiority design. Subjects over 20 years old with confirmed H. pylori infection were enrolled prospectively from Fu Jen Catholic University Hospital. They were randomly assigned to the VAC‐7 or S‐14 group. The primary endpoint was the eradication rate in first‐line treatment, evaluated by urea breath test, with noninferiority determined using the Farrington–Manning method. The secondary outcome included adverse effect rates and compliance, assessed through self‐administered questionnaires. Results: Between December 2021 and June 2023, a total of 628 patients were recruited. The eradication rates by per‐protocol analysis and intention‐to‐treat analysis were 88.6%/81.8% for VAC‐7 and 90.3%/81.4% for S‐14, respectively. The VAC‐7 was non‐inferior to S‐14 in terms of ITT analysis. Subjects experienced fewer incidences of nausea, anorexia, dizziness, fatigue, and any severe adverse events in the VAC‐7 group. Compliance was higher in the VAC‐7 group, with 94% taking all the pills correctly. Conclusions: Our findings supported the use of 7‐day vonoprazan triple therapy with high‐dose amoxicillin as the standard first‐line treatment for H. pylori infection. Trial Registration:ClinicalTrials.gov identifier: NCT05371249 [ABSTRACT FROM AUTHOR]

Background and Aim: Vonoprazan as a new acid blocker has more potency and longer lasting acid suppression than proton pump inhibitors. Whether the efficacy of vonoprazan‐based triple therapy is comparable with or even better than that of currently recommended first‐line therapies is still unknown. Our study aims to compare the eradication rate and major adverse effects between 7‐day vonoprazan‐based triple therapy with high‐dose amoxicillin and 14‐day extended sequential therapy. Methods: We performed a retrospective analysis from the database of 13C‐urea breath test at Fu Jen Catholic University Hospital. All patients with a definite diagnosis of Helicobacter pylori infection by rapid urease test, urea breath test, stool antigen test, or pathology report were recruited. Patients receiving first‐line regimens with vonoprazan‐based triple therapy or extended sequential therapy were included. The respective eradication rate determined by 13C‐urea breath test and major adverse effects were demonstrated. Results: Totally, 106 patients were recruited in the vonoprazan‐based triple therapy group and 357 in the extended sequential therapy group. There was no significant difference in eradication rate between vonoprazan‐based triple therapy with high‐dose amoxicillin and extended sequential therapy (83.0 vs 88.8%, P = 0.12). Major adverse effects occurred in 13 of the extended sequential therapy group but none in the other group (0% vs 3.6%, P = 0.046). Conclusions: Seven‐day vonoprazan‐based triple therapy with high‐dose amoxicillin is a potential first‐line anti‐Helicobacter pylori regimen alternative to current standard treatment, with the advantages of simplicity, short treatment duration, low pill burden, and fewer major adverse effects. [ABSTRACT FROM AUTHOR]

A 47-year-old man with chronic hepatitis B had progressive elevated alpha-fetoprotein of 2 years' duration. A pancreatic tail tumor, instead of liver tumor, was detected. He underwent elective distal pancreatectomy and splenectomy and the pathology turned out to be acinar cell carcinoma of the pancreas. Serum level of alpha-fetoprotein returned to normal soon after surgery. No cancer recurrence was noted after 3 years of follow-up. Alpha-fetoprotein is commonly used as a tumor marker to screen for hepatocellular carcinoma in high-risk patients. However, elevated alpha-fetoprotein could occur in a much rarer disease, acinar cell carcinoma of the pancreas. [ABSTRACT FROM AUTHOR]