Differences and trends in worldwide clinical guidelines for Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection is the most common human infection worldwide, affecting approximately 40-60% of the global population. Eradication therapy is the primary treatment for preventing the development of peptic ulcers and gastric cancer. H. pylori eradication regimens should be selected based on those expected to achieve the highest eradication rates at treatment initiation in the area/country. In general, eradication regimens capable of achieving eradication rates of ≥90% are considered optimal. The success or failure of eradication therapy depends on several factors, including susceptibility to the antimicrobial agents used, inadequate acid inhibition during therapy, and poor medication adherence. Clinical guidelines and consensus reports for H. pylori infections are periodically updated worldwide. Recommended eradication regimens evolve in response to changing regional antibiotic resistance patterns, the introduction of new antimicrobial agents and acid-suppressing therapies, and regional insurance system-related challenges. Therefore, eradication regimens vary depending on the region covered by specific guidelines and consensus reports. This review aimed to explain regional differences in clinical guidelines and consensus reports for H. pylori infection, track their changes over time, and summarize future directions for eradication therapy.