Mutation-driven mechanisms underlying antibiotic resistance of Helicobacter pylori in Asia: A systematic review and...

More than half of the global population is infected with Helicobacter pylori (H. pylori). Rising antibiotic resistance has weakened the effectiveness of conventional eradication therapies. We conducted a systematic review and meta-analysis of studies published between 2000 and 2024 across Asia to evaluate the relationship between antibiotic resistance and mutations.

We did a systematic review and meta-analysis of primary antibiotic resistance to H. pylori and efficacy of first-line regimens in the Asia-Pacific region. Database such as Google Scholar, PubMed, Science Direct, and Web of Science were searched to find research papers published between 2000 and 2024. To evaluate heterogeneity, statistical techniques such as meta-regression, I² statistics, and Cochran's Q test were used. The data were then combined into forest plots.

Clarithromycin resistance in H. pylori is mainly driven by A2142G/A2143G mutations (19-34%), while metronidazole resistance exceeds 84% in East Asia via rdxA mutations. Amoxicillin resistance (6-34%) links to pbp1A variants, and levofloxacin resistance (31-66%) to gyrA/B mutations. The high heterogeneity highlights the need for standardized diagnostics and region-specific therapies.

According to this study, H. pylori resistance is caused by genetic alterations throughout Asia. Treatments tailored to a certain region and ongoing monitoring are necessary due to rising antibiotic resistance. Regional trends are influenced by variations in antibiotic use, bacterial genomes, and medical procedures. Improving diagnoses, raising clinical awareness, using antibiotics responsibly, and fostering international cooperation that is adapted to local conditions are all necessary to meet these problems.