Helicobacter pylori eradication: a narrative review
Abstract
Background: Helicobacter pylori (H. pylori) is one of the most common chronic infections worldwide and a primary cause of peptic ulcer disease and gastric cancer. Increasing antibiotic resistance has made eradication more difficult, emphasizing the need for new strategies. This narrative review summarizes the current evidence on H. pylori eradication, focusing on epidemiology, resistance, treatment regimens, adjunctive therapies, cancer prevention, and extra-gastric outcomes.
Evidence and methods: We conducted a narrative literature search to identify current evidence on strategies for eradicating H. pylori. Both first-line and salvage regimens were considered, as well as adjunctive and novel approaches. The evidence was organized thematically.
Results: Over half of the world's population is infected with H. pylori, with the highest prevalence observed in Africa, South America, and Asia. Clarithromycin resistance exceeds 15%-20% in most regions, which diminishes the effectiveness of standard triple therapy. Current recommendations for first-line treatments in areas with high resistance include bismuth quadruple and concomitant regimens, which achieve eradication rates above 85%. Vonoprazan-based and high-dose dual therapies also show promise as alternative options. For second-line therapy, levofloxacin- and bismuth-based regimens remain effective, while rifabutin and susceptibility-guided approaches offer salvage options. Additionally, probiotics and N-acetylcysteine have…
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