Polysaccharide-based therapeutic approaches for the eradication of gastric Helicobacter pylori

Helicobacter pylori infects over half of the global population and is a major cause of gastritis, peptic ulcer disease, and gastric cancer. Although antibiotic-based regimens remain the clinical standard, their efficacy is being increasingly compromised by rising antimicrobial resistance, poor gastric retention, and adverse side effects. This review explores polysaccharide-based strategies as adjunctive or alternative approaches. Sulphated polysaccharides inhibit bacterial adhesion and biofilm formation while modulating inflammatory pathways, whereas chitosan provides mucoadhesive properties. Alginate, pectin, guar gum, and Bletilla striata polysaccharide (BSP) contribute protective gel formation, anti-ulcer effects, and mucosal healing. They have been employed as gastroretentive matrices, biofilm-disrupting materials, and functional excipients in nanoparticles and hydrogels. However, clinical and preclinical evidence suggests that polysaccharides largely act as adjuncts without consistently increasing eradication rates, highlighting key translational barriers such as limited standalone bactericidal activity and compositional variability. Future directions should include the development of hybrid, multi-layered systems integrating retention, anti-adhesion, and controlled release, alongside targeting of resistant bacterial forms. This review will guide future experimental design and support the development of safer, gastroretentive, and resistance-conscious therapies for next-generation H. pylori treatment.