[Current situation and consideration for Helicobacter pylori eradication therapy in special populations]

Helicobacter pylori (Hp) infection is associated with a wide range of diseases. Bismuth quadruple therapy is currently the first-line regimen for Hp eradication in China. However, potential adverse effects of the acid suppressants, antibiotics, and bismuth agents included in this regimen may increase the risk of adverse events in the elderly and patients with liver dysfunction, renal dysfunction, hypertension, diabetes and other diseases. Moreover, complex drug interactions between eradication therapies and medications for pre-existing conditions further elevate clinical risks. Currently, major domestic and international guidelines generally lack specific recommendations for Hp eradication in these special populations, posing significant challenges in clinical practice. To address this gap, the paper reviewed relevant guidelines on Hp treatment at home and abroad, and systematically summarized the pathophysiological characteristics and potential drug interactions in special populations, including the elderly and those with liver and renal dysfunction, cardio cerebrovascular and metabolic diseases. Based on the latest evidence, individualized treatment strategies, including drug selection, dose adjustment, use of dual therapy and susceptibility-guided precision therapy, were proposed, aiming to provide practical guidance for clinicians.