VI Spanish Consensus Conference on the treatment of Helicobacter pylori infection

Helicobacter pylori (H. pylori) infection is highly prevalent in the Spanish population and is the main cause of chronic gastritis, peptic ulcer disease, and gastric cancer. Five previous consensus meetings on the management of H. pylori infection in Spain have been held, the most recent in 2021. Changes in treatment regimens and the growing body of available evidence justified the organization of this VI Spanish Consensus Conference in June 2026, focused on the treatment of this infection. Sixteen experts in the field participated, performed a systematic literature search, and developed 25 recommendations, which were subsequently submitted to an iterative process of serial anonymous voting using Delphi methodology. The GRADE system was used to classify the certainty of the evidence and the strength of the recommendations. As a starting point, this consensus establishes that the recommended treatments should achieve, and preferably exceed, a 90 % cure rate when administered empirically. Accordingly, quadruple regimens are recommended as both first-line and rescue treatments. As first-line treatment, a 10-day regimen with a proton pump inhibitor plus bismuth, tetracycline, and metronidazole (Pylera®) is recommended. After failure of this regimen, a combination of a proton pump inhibitor, amoxicillin, levofloxacin, and bismuth is recommended. This consensus also provides a detailed review of other rescue treatment alternatives.