Helicobacter pylori eradication: a narrative review

Area of Science:

• Gastroenterology and Infectious Diseases
• Microbiology and Immunology
• Oncology

Background:

• Helicobacter pylori infection is a global health challenge, causing peptic ulcers and gastric cancer.
• Rising antibiotic resistance complicates H. pylori eradication, necessitating novel treatment strategies.
• This review examines current evidence on H. pylori eradication, including epidemiology, resistance, and therapeutic approaches.

Purpose of the Study:

• To review current evidence on H. pylori eradication strategies.
• To focus on epidemiology, antibiotic resistance, and treatment outcomes.
• To identify effective first-line, salvage, and adjunctive therapies.

Main Methods:

• A narrative literature search was conducted.
• Evidence on H. pylori eradication was identified and organized thematically.
• First-line, salvage, and adjunctive treatment approaches were evaluated.

Main Results:

• H. pylori infects over half the global population, with high prevalence in Africa, South America, and Asia.
• Clarithromycin resistance exceeds 15%-20% in many regions, reducing standard triple therapy efficacy.
• Bismuth quadruple, concomitant, vonoprazan-based, and high-dose dual therapies show >85% eradication rates; probiotics and N-acetylcysteine improve outcomes.

Conclusions:

• H. pylori eradication is crucial for gastric cancer prevention and improving gastrointestinal and systemic health.
• Treatment strategies must adapt to local resistance patterns and incorporate adjunctive therapies.
• Molecular antimicrobial sensitivity testing and targeted eradication programs are essential for high-prevalence areas.