{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:18:03Z","timestamp":1786598283942,"version":"build-2736575974"},"reference-count":59,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":44,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Helicobacter"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Antimicrobial resistance undermines empirical first\u2010line regimens for\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Helicobacter pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      . We compared susceptibility\u2010guided therapy (SGT) versus empirical therapy in adults receiving first\u2010line treatment, focusing on intention\u2010to\u2010treat (ITT) eradication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We searched MEDLINE (PubMed), Web of Science, and Scopus from inception to 30 September 2025 for randomized controlled trials (RCTs) and non\u2010randomized comparative studies (NRS) in adults with confirmed\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>H. pylori<\/jats:italic>\n                      <\/jats:styled-content>\n                      . Interventions included phenotypic (culture\/E\u2010test) or genotypic (PCR) SGT applied to biopsy, stool, or gastric juice specimens; comparators were empirical regimens including bismuth quadruple therapy (BQT) and non\u2010BQT options. The primary outcome was ITT eradication. We pooled risk ratios (RR) with DerSimonian\u2013Laird random\u2010effects, reported I\n                      <jats:sup>2<\/jats:sup>\n                      \/\u03c4\n                      <jats:sup>2<\/jats:sup>\n                      , and derived 95% prediction intervals (PI). Subgroups were prespecified by comparator family (BQT vs. other) and specimen\/method. Multi\u2010arm studies combined empirical arms within family or split across distinct families.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010two studies met inclusion criteria; all contributed ITT data. RCTs (k\u2009=\u200933) favored SGT over empirical therapy (pooled RR 1.09, 95% CI 1.05\u20131.13; I\n                      <jats:sup>2<\/jats:sup>\n                      73%; 95% PI 0.92\u20131.30). NRS (k\u2009=\u200912) were directionally consistent (pooled RR 1.15, 95% CI 1.10\u20131.22; I\n                      <jats:sup>2<\/jats:sup>\n                      75%; 95% PI 0.99\u20131.35). In RCTs, effects were neutral\u2010to\u2010modest vs. BQT (RR 1.03, 95% CI 0.97\u20131.10) and clearer vs. other empirical regimens (RR 1.12, 95% CI 1.06\u20131.18).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adult first\u2010line therapy, SGT achieves at least non\u2010inferior\u2014and often superior\u2014eradication versus empirical regimens; the incremental benefit is attenuated where BQT is standard. These findings support selective, and increasingly justified, integration of susceptibility testing in settings with clinically relevant resistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hel.70125","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:01:46Z","timestamp":1776229306000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Susceptibility\u2010Guided Versus Empirical First\u2010Line Therapy of\n                    <scp>\n                      <i>Helicobacter pylori<\/i>\n                    <\/scp>\n                    Infection in Adults: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3130-4184","authenticated-orcid":false,"given":"Manuel Coelho","family":"Rocha","sequence":"first","affiliation":[{"name":"Unilabs  Lisbon Portugal"},{"name":"NOVA Medical School Universidade NOVA de Lisboa  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"Gaspar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Bernardes","sequence":"additional","affiliation":[{"name":"Unilabs  Lisbon Portugal"},{"name":"NOVA Medical School Universidade NOVA de Lisboa  Lisboa Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Pimentel","family":"Nunes","sequence":"additional","affiliation":[{"name":"Unilabs  Lisbon Portugal"},{"name":"Department of Surgery and Physiology, Faculty of Medicine University of Porto (FMUP)  Porto Portugal"},{"name":"RISE@CI\u2010IPO (Health Research Network) IPO\u2010Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-023-00431-8"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.007"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hel.13091"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2022-327745"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000519413"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1756284820968736"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2000.00870.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.2003.01757.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-5378.2006.00407.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.clpt.6100043"},{"key":"e_1_2_7_14_1","first-page":"S171","article-title":"Tailored 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