{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:20:57Z","timestamp":1783084857164,"version":"3.54.6"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Gastroenterol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      (\n                      <jats:italic>H. pylori<\/jats:italic>\n                      ) 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\n                      <jats:italic>H. pylori<\/jats:italic>\n                      eradication, focusing on epidemiology, resistance, treatment regimens, adjunctive therapies, cancer prevention, and extra-gastric outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence and methods<\/jats:title>\n                    <jats:p>\n                      We conducted a narrative literature search to identify current evidence on strategies for eradicating\n                      <jats:italic>H. pylori<\/jats:italic>\n                      . Both first-line and salvage regimens were considered, as well as adjunctive and novel approaches. The evidence was organized thematically.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over half of the world\u2019s population is infected with\n                      <jats:italic>H. pylori<\/jats:italic>\n                      , 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 been found to improve eradication rates and treatment tolerability. Successful eradication reduces the risk of gastric cancer, particularly in East Asia, and provides benefits for extra-gastric conditions such as iron deficiency anemia, idiopathic thrombocytopenic purpura, and pregnancy-related complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Eradicating\n                      <jats:italic>H. pylori<\/jats:italic>\n                      is crucial for preventing gastric cancer and enhancing gastrointestinal and systemic health. Achieving success necessitates adapting treatment to resistance patterns, employing adjunctive strategies, using molecular antimicrobial sensitivity testing, and implementing eradication programs in areas with high prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgstr.2026.1823571","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:07:59Z","timestamp":1782882479000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Helicobacter pylori eradication: a narrative review"],"prefix":"10.3389","volume":"5","author":[{"given":"Tarig","family":"Fadelelmoula","sequence":"first","affiliation":[{"name":"Department of Medicine, College of Medicine and Health Sciences, National University of Science and Technology","place":["Sohar, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdi","family":"Al Mutori","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine and Health Sciences, National University of Science and Technology","place":["Sohar, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine and Health Sciences, National University of Science and Technology","place":["Sohar, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazin","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine and Health Sciences, National University of Science and Technology","place":["Sohar, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Al Reesi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Sohar Hospital","place":["Sohar, Oman"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.04.022","article-title":"Global prevalence of Helicobacter pylori infection: Systematic review and meta-analysis","volume":"153","author":"Hooi","year":"2017","journal-title":"Gastroenterology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.16526","article-title":"Revolution of Helicobacter pylori treatment","volume":"39","author":"Yamaoka","year":"2024","journal-title":"J Gastroenterol Hepatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/hel.12165","article-title":"Epidemiology of Helicobacter pylori infection","author":"Eusebi","year":"2014","journal-title":"Helicobacter"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.epirev.a018040","article-title":"Helicobacter pylori: Epidemiology and routes of transmission","volume":"22","author":"Brown","year":"2000","journal-title":"Epidemiol Rev"},{"key":"B5","doi-asserted-by":"publisher","first-page":"15491","DOI":"10.1038\/s41598-017-15490-7","article-title":"Changing trends in the prevalence of H. pylori infection in Japan (1908-2003): a systematic review and meta-regression analysis of 170,752 individuals","volume":"7","author":"Wang","year":"2017","journal-title":"Sci Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1046\/j.1365-2036.11.s1.5.x","article-title":"Helicobacter pylori and the risk and management of associated diseases: Gastritis, ulcer disease, atrophic gastritis and gastric cancer","author":"Kuipers","year":"1997","journal-title":"Aliment Pharmacol Ther"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.canlet.2010.07.014","article-title":"Helicobacter pylori in the pathogenesis of gastric cancer and gastric lymphoma","volume":"305","author":"Kim","year":"2011","journal-title":"Cancer Lett"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1053\/j.gastro.2016.01.028","article-title":"Association between Helicobacter pylori eradication and gastric cancer incidence: A systematic review and meta-analysis","volume":"150","author":"Lee","year":"2016","journal-title":"Gastroenterology"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-320839","article-title":"Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis","volume":"69","author":"Ford","year":"2020","journal-title":"Gut"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-5378.2008.00617.x","article-title":"Helicobacter pylori infection and iron stores: A systematic review and meta-analysis","volume":"13","author":"Muhsen","year":"2008","journal-title":"Helicobacter"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1080\/09537100500438057","article-title":"Helicobacter pylori-associated immune thrombocytopenia","volume":"17","author":"Franchini","year":"2006","journal-title":"Platelets"},{"key":"B12","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1055\/s-0028-1109062","article-title":"Helicobacter pylori und gastroduodenale Ulkuskrankheit\" der Deutschen Gesellschaft f\u00fcr Verdauungs- und Stoffwechselkrankheiten (DGVS) [S3-guideline \"Helicobacter pylori and gastroduodenal ulcer disease","volume":"47","author":"Fischbach","year":"2009","journal-title":"Z Gastroenterol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1038\/ncpgasthep1138","article-title":"New concepts of resistance in the treatment of Helicobacter pylori infections","volume":"5","author":"Graham","year":"2008","journal-title":"Nat Clin Pract Gastroenterol Hepatol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13497","article-title":"Review article: The global emergence of Helicobacter pylori antibiotic resistance","volume":"43","author":"Thung","year":"2016","journal-title":"Aliment Pharmacol Ther"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2017.0292","article-title":"Antibiotic resistance of Helicobacter pylori in Iranian children: A systematic review and meta-analysis","volume":"24","author":"Yousefi-Avarvand","year":"2018","journal-title":"Microb Drug Resist"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1053\/j.gastro.2018.07.007","article-title":"Prevalence of antibiotic resistance in Helicobacter pylori: A systematic review and meta-analysis in World Health Organization regions","volume":"155","author":"Savoldi","year":"2018","journal-title":"Gastroenterology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12879-025-12289-0","article-title":"Empirical therapy versus tailored therapy for Helicobacter pylori infection? A systematic review","volume":"26","author":"Zivarifar","year":"2025","journal-title":"BMC Infect Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1136\/gutjnl-2016-312288","article-title":"Management of Helicobacter pylori infection-the Maastricht V\/Florence Consensus Report","volume":"66","author":"Malfertheiner","year":"2017","journal-title":"Gut"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009034.pub2","article-title":"Sequential versus standard triple first-line therapy for Helicobacter pylori eradication","volume":"2016","author":"Nyssen","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.563","article-title":"ACG Clinical Guideline: Treatment of Helicobacter pylori infection","volume":"112","author":"Chey","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13020136","article-title":"Sequential versus standard triple therapy for first-line Helicobacter pylori eradication: An update","volume":"13","author":"Nyssen","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i14.4345","article-title":"Probiotics in Helicobacter pylori eradication therapy: A systematic review and meta-analysis","volume":"21","author":"Zhang","year":"2015","journal-title":"World J Gastroenterol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1038\/srep23522","article-title":"Probiotic supplementation does not improve eradication rate of Helicobacter pylori infection compared to placebo based on standard therapy: A meta-analysis","volume":"6","author":"Lu","year":"2016","journal-title":"Sci Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.02868.x","article-title":"Systematic review: Are probiotics useful in controlling gastric colonization by Helicobacter pylori","volume":"23","author":"Gotteland","year":"2006","journal-title":"Aliment Pharmacol Ther"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1097\/01.smj.0000182486.39913.da","article-title":"Effect of N-acetyl cysteine on Helicobacter pylori","volume":"98","author":"Gurbuz","year":"2005","journal-title":"South Med J"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012357.pub2","article-title":"N-acetylcysteine as an adjuvant therapy for Helicobacter pylori eradication","volume":"2","author":"Fontes","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-311304","article-title":"Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: A phase III, randomised, double-blind study","volume":"65","author":"Murakami","year":"2016","journal-title":"Gut"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.07.043","article-title":"Host genetic determinants associated with Helicobacter pylori eradication treatment failure: A systematic review and meta-analysis","volume":"161","author":"Shah","year":"2021","journal-title":"Gastroenterology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1053\/j.gastro.2023.08.028","article-title":"Gastric intestinal metaplasia: Real culprit or innocent bystander as a precancerous condition for gastric cancer","volume":"165","author":"Sugano","year":"2023","journal-title":"Gastroenterology"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.2.187","article-title":"Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: A randomized controlled trial: A randomized controlled trial","volume":"291","author":"Wong","year":"2004","journal-title":"JAMA"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03153-w","article-title":"Gastric cancer prevention by community eradication of Helicobacter pylori: A cluster-randomized controlled trial","volume":"30","author":"Pan","year":"2024","journal-title":"Nat Med"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005583.pub3","article-title":"Helicobacter pylori eradication for the prevention of gastric neoplasia","volume":"7","author":"Ford","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s10120-016-0658-5","article-title":"Changing epidemiology of Helicobacter pylori in Japan","volume":"20","author":"Inoue","year":"2017","journal-title":"Gastric Cancer"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1111\/hel.12330","article-title":"An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia","volume":"22","author":"Hudak","year":"2017","journal-title":"Helicobacter"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1683974","article-title":"Management of Helicobacter pylori in patients with immune thrombocytopenia","volume":"39","author":"Vanegas","year":"2019","journal-title":"Hamostaseologie"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.11.059","article-title":"Functional gastroduodenal disorders","volume":"130","author":"Tack","year":"2006","journal-title":"Gastroenterology"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v22.i12.3486","article-title":"Helicobacter pylori eradication therapy for functional dyspepsia: Systematic review and meta-analysis","volume":"22","author":"Du","year":"2016","journal-title":"World J Gastroenterol"},{"key":"B38","article-title":"Helicobacter pylori infection in systemic sclerosis: A systematic review and meta-analysis of observational studies","author":"Yong","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2020-000490","article-title":"Helicobacter pylori infection and micronutrient deficiency in pregnant women: A systematic review and meta-analysis","volume":"7","author":"Afsar","year":"2020","journal-title":"BMJ Open Gastroenterol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1186\/s41043-024-00630-3","article-title":"The association between the Helicobacter pylori infection and the occurrence of gestational diabetes: A systematic review and meta-analysis","volume":"43","author":"Kohnepoushi","year":"2024","journal-title":"J Health Popul Nutr"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000021832","article-title":"Association between Helicobacter pylori infection and the risk of colorectal cancer: A systematic review and meta-analysis: A systematic review and meta-analysis","volume":"99","author":"Zuo","year":"2020","journal-title":"Med (Baltimore)"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000022975","article-title":"Association between Helicobacter pylori infection and irritable bowel syndrome: A systematic review and meta-analysis","volume":"99","author":"Li","year":"2020","journal-title":"Med (Baltimore)"}],"container-title":["Frontiers in Gastroenterology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgstr.2026.1823571\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:35:31Z","timestamp":1783082131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgstr.2026.1823571\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":42,"alternative-id":["10.3389\/fgstr.2026.1823571"],"URL":"https:\/\/doi.org\/10.3389\/fgstr.2026.1823571","relation":{},"ISSN":["2813-1169"],"issn-type":[{"value":"2813-1169","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1823571"}}