The Fifth Mexican consensus on the diagnosis and treatment of Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection remains highly prevalent in Mexico and worldwide. In response to the advances in diagnosis, treatment, and epidemiologic surveillance, the Asociación Mexicana de Gastroenterología, through a multidisciplinary panel of experts, developed the "Fifth Mexican Consensus on H. pylori" in 2025, providing 38 evidence-based recommendations tailored to the Mexican context. The document highlights the establishment of the Hp-MexReg national registry and its collaboration with Hp-LatamReg and HpRESLA projects, enabling the collection of local data on eradication rates and antimicrobial resistance. The expert group reaffirms the high prevalence of H. pylori in Mexico (70.5%) related to social and sanitation factors, as well as the increase of antibiotic-resistant strains, particularly to clarithromycin and levofloxacin. Regarding diagnosis, the 13C-urea breath test is prioritized as the first-line noninvasive method and eradication of the bacterium should be confirmed at least four weeks after treatment. Regarding treatment, quadruple therapies, with or without bismuth, are recommended over standard triple therapy, and potassium-competitive acid blockers are endorsed as an effective alternative to high-dose proton pump inhibitors. H. pylori eradication is strongly recommended, with emphasis on the clinical scenarios in which it is indicated. The present consensus underscores the need to continue conducting national studies that enable strategies to be adapted to Mexico's epidemiologic reality.