Antibiotic heteroresistance: an important factor in the failure of Helicobacter Pylori eradication

Heteroresistance of bacteria refers to the presence of bacterial subgroups with different antibiotic sensitivity in the same strain, affecting the bacterial eradication effect. In recent years, heteroresistance has posed significant challenges to H. pylori eradication failure, while little is known about heteroresistance to H. pylori. Facing the current growing heteroresistance and declining eradication rates of H. pylori, it is necessary to comprehensively understand the epidemiology of heteroresistance as well as detection methods, and elucidate the relevant resistance mechanisms to find a more ideal precision treatment. In this study, we systematically review the current studies of H. pylori heteroresistance and summarize the detection methods and possible heteroresistance mechanisms. In brief, it is highly significant to further strengthen the general understanding for H. pylori heteroresistance. Accordingly, it is necessary to conduct extensive clinical studies on the incidence of H. pylori heteroresistance and to refine the clinical definition of H. pylori heteroresistance. The development of accurate and standardized detection technology is the key to heteroresistance diagnosis. In addition, we strongly advocate to further study the heteroresistance mechanism of H. pylori in vivo and in vitro, which will advance the development of more effective treatment strategies and facilitate the refinement of clinical guidelines.