The importance of Helicobacter pylori eradication: a narrative review

Helicobacter pylori (H. pylori) is a gram-negative bacterium infecting over 40% of the global population, with highest prevalence in low- and middle-income regions. Chronic infection leads to persistent gastritis and can result in peptic ulcer disease, dyspepsia and gastric adenocarcinoma. Despite its high pathogenic potential, population-based screening and eradication programmes remain limited, particularly in Europe.

This narrative review summarisescurrent evidence on the epidemiology, clinical burden and eradication strategies for H. pylori. A literature search of PubMed, Embase and the Cochrane Database was performed to identify recent publications relating to H. pylori infection, consequences and screening approaches.

H. pylori has been classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen and is the leading cause of infection-attributable cancer worldwide, accounting for approximately 850,000 gastric cancer cases annually. Robust evidence demonstrates that eradication of H. pylori reduces the risk of peptic ulcer recurrence, dyspepsia, and gastric cancer incidence, with recent meta-analyses reporting a pooled relative risk reduction of up to 44%. Population-based eradication initiatives, such as the Matsu Islands study, have shown dramatic declines in H. pylori prevalence, peptic ulceration, and gastric cancer incidence. Current international guidelines, including the Maastricht VI/Florence and 2025 Taipei Global Consensus reports, now recommend universal eradication of confirmed infections and support population-level or family-based screening in high-risk regions. Ongoing European pilot studies, including the TOGAS initiative, aim to inform the implementation of gastric cancer screening programs. Concerns regarding antibiotic resistance remain, though recent evidence suggests that the risks are manageable with appropriate antibiotic stewardship.

Population-based H. pylori screen-and-treat strategies represent a cost-effective and evidence-based approach to preventing gastric cancer. Further large-scale European studies are warranted to guide optimal implementation, timing, and cost-effectiveness of such programs.