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Updated: Dec 11, 2025

Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Update on the Management of Helicobacter pylori Infection
Nasir Saleem1, Colin W Howden1
1Division of Gastroenterology, University of Tennessee College of Medicine, 956 Court Avenue, Suite H210, Memphis, TN 38163 USA.
Purpose Of Review:
Our purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities.
Recent Findings:
Increasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. Molecular-based genotypic testing for antibiotic resistance and an effective H. pylori vaccine remain under development.
Summary:
Inability to test for antibiotic resistance renders treatment selection empiric. However, resistance to rifabutin and amoxicillin remains rare. Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing.
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