Related Experiment Video
Updated: Nov 15, 2025
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
[Helicobacter pylori: When to look for an infection and treat it in adults?]
1Université de Lorraine, CHRU-Nancy, département de médecine interne et immunologie clinique-BPC, rue du Morvan, 54511 Vandœuvre-Lès-Nancy cedex, France.
Insights
Helicobacter pylori infection, a common childhood acquisition, causes gastritis and related diseases. Updated French guidelines recommend specific 10-day triple or 14-day quadruple therapies for eradication, with mandatory follow-up.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Helicobacter pylori infection is acquired in childhood, primarily within families.
- It leads to chronic gastritis and is associated with various digestive and extra-digestive conditions.
- Disease progression is influenced by bacterial, host, and environmental factors.
Purpose of the Study:
- To present updated French recommendations for Helicobacter pylori research and treatment (2017).
- To outline indications for eradication therapy based on evidence levels.
- To detail diagnostic and therapeutic strategies, including antibiotic resistance considerations.
Main Methods:
- Review of French guidelines updated in 2017.
- Categorization of indications for H. pylori eradication based on evidence level (high and lower).
- Description of diagnostic methods (gastric biopsies, non-invasive tests) and recommended treatment regimens (triple and quadruple therapies).
Main Results:
- High-level evidence supports eradication for peptic ulcer, NSAID/aspirin use with ulcer history, MALT lymphoma, and gastric cancer resection.
- Lower-level evidence supports eradication for functional dyspepsia, gastric adenocarcinoma risk factors, unexplained anemias, ITP, and post-bariatric surgery.
- Recommended first-line treatment is 10-day triple therapy guided by antibiotic sensitivity testing, with 14-day quadruple therapy as an alternative.
Conclusions:
- Updated recommendations provide a framework for H. pylori management in France.
- Tailoring treatment based on antibiotic resistance is crucial for effective eradication.
- Eradication control is a necessary component of the treatment protocol.
Abstract:
Helicobacter pylori infection is acquired during childhood mainly within the family. It causes active chronic gastritis associated with the development of many digestive and extra digestive diseases. Its expression results from interactions between the bacteria, the host and environmental factors modulating the evolution of gastritis and acid secretion. The French recommendations for research and treatment for curative or preventive purposes were updated in 2017. These are indications with a high level of evidence for association and efficacy of the eradication treatment: peptic ulcer, taking non-steroidal anti-inflammatory drugs or aspirin with an ulcer history, gastric MALT lymphoma, and localized resection of gastric cancer. The recommendations relate to other diseases with a lower level of evidence: functional dyspepsia, risk factors for gastric adenocarcinoma (family history of gastric cancer, Lynch syndrome, pre-neoplastic lesions: atrophy, intestinal metaplasia, dysplasia), unexplained iron deficiency anemia and vitamin B12 deficiency, immunological thrombocytopenic purpura, bariatric surgery isolating part of the stomach. The diagnosis is made by examining gastric biopsies or by non-invasive test depending on the clinical situation. The 10-day triple therapies guided by the study of antibiotic sensitivity (proton pump inhibitors (PPI), amoxicillin, clarithromycin or levofloxacin) are recommended as first-line treatment because of the increase in resistance, allowing the reduction of the duration of treatment, the number of antibiotics and side effects. By default, probabilistic quadruple therapies of 14 days are possible and interchangeable (PPI with amoxicillin, clarithromycin, metronidazole, or a combination of bismuth salt, tetracycline and metronidazole). Eradication control is necessary.
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