HELICOBACTER PYLORI INFECTION: DIAGNOSIS, ERADICATION THERAPY, AND THE CHALLENGE OF ANTIBIOTIC RESISTANCE

Abstract

Background: Helicobacter pylori is a gram-negative, spiral bacterium that chronically colonizes the gastric mucosa of a large proportion of the world's population and is classified by the International Agency for Research on Cancer as a definite (Group I) human carcinogen. Untreated infection drives a stepwise progression from chronic gastritis to peptic ulcer disease and, in a subset of patients, gastric cancer, while rising global antibiotic resistance increasingly threatens the success of standard eradication regimens.

Methods: This narrative review synthesizes current evidence on the diagnosis, eradication therapy, and antibiotic resistance patterns of H. pylori infection, drawing on the Maastricht VI/Florence Consensus Report and the 2024 American College of Gastroenterology (ACG) clinical guideline.

Results: Diagnostic testing must be selected according to clinical context and recent medication use, since proton pump inhibitors, bismuth, and antibiotics can all produce false-negative results; the urea breath test and stool antigen test are the preferred non-invasive options, while endoscopic biopsy-based testing additionally allows histological assessment and, where available, culture-based susceptibility testing. Rising clarithromycin resistance, now exceeding 15% in many world regions, has rendered standard clarithromycin-based triple therapy unreliable as an empiric first-line choice in high-resistance settings; bismuth quadruple therapy and susceptibility-guided regimens are increasingly preferred, together with extension of treatment duration to 14 days and mandatory confirmation of eradication.

Conclusion: Antibiotic resistance has fundamentally shifted first-line H. pylori management away from one-size-fits-all empiric triple therapy toward regionally informed, often bismuth-based quadruple regimens, with confirmation of eradication as a routine step. This shift is directly relevant to Uzbekistan and other settings with anticipated high regional clarithromycin resistance and limited access to routine susceptibility testing, where bismuth-based regimens and antimicrobial stewardship offer a practical, high-yield strategy.