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Publications

Journal Article Review Ahead of print 4 citations

PubMed: 42310251 DOI: 10.1111/apt.70798

Review Article: Implementation Challenges in Helicobacter pylori Management: Bridging Evidence and Real-World Practice.

Aliment Pharmacol Ther

Authors: Duc Trong Quach, Jyh-Ming Liou, Javier P Gisbert, Wai Keung Leung, Steven F Moss, Carlo A Fallone, Peter Katelaris, Christian Schulz, Violet Kayamba, Liya Zhou, Nhu Thi Hanh Vu, Ratha-Korn Vilaichone, Muhammad Miftahussurur, Mashiko Setshedi, Arnoldo Riquelme, Abbas Yadegar, Yeong Yeh Lee, Fumiaki Ishibashi, Hwoon-Yong Jung, Luiz Gonzaga Coelho, Hidekazu Suzuki, Yi-Chia Lee, Francis Megraud, Varocha Mahachai, Kentaro Sugano, Peter Malfertheiner

Affiliations

  • Department of Internal Medicine and Gastro-Hepato Integrated Research Team (GHIRT-002.TCM2025), University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
  • Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam.
  • Departments of Internal Medicine and Medical Research, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
  • Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
  • Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
  • Brown University, Providence, Rhode Island, USA.
  • Division of Gastroenterology, McGill University Health Center, Montreal, Canada.
  • Gastroenterology Department, Concord Hospital, University of Sydney, Camperdown, New South Wales, Australia.
  • Medical Department 2, LMU Hospital, Ludwig-Maximilians-University, Munich, Germany.
  • School of Medicine, University of Zambia, Lusaka, Zambia.
  • Department of Gastroenterology, Beijing Key Laboratory of Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Peking University Third Hospital, Beijing, China.
  • Center of Excellence in Digestive Diseases and Gastroenterology Unit, Department of Medicine and Thailand Science Research and Innovation Fundamental Fund, Thammasat University, Klong Luang, Thailand.
  • Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia.
  • Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
  • University of Cape Town, Cape Town, South Africa.
  • Departamento de Gastroenterologia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Instituto de Medicina, Red Salud UC Christus, Santiago, Chile.
  • Centro de prevención y Control del Cáncer (CECAN), Santiago, Chile.
  • Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
  • Digestive Disease Center, Showa Medical University Northern Yokohama Hospital, Yokohama, Japan.
  • Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • Alfa Institute of Gastroenterology, Clinics Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
  • Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara City, Japan.
  • INSERM U1312 BRIC, University of Bordeaux, Bordeaux, France.
  • Jichi Medical University, Shimotsuke, Japan.
  • Medical Clinic II, Ludwig Maximilian University, Munich, Germany.
  • University Clinic, Medical Department II, LMU, Munich, Germany.

Abstract

BACKGROUND

Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real-world outcomes of Helicobacter pylori management remain variable. Antimicrobial resistance alone does not fully explain these discrepancies, suggesting important challenges in the implementation of evidence-based care.

AIMS

To identify recurring implementation-related challenges across the Helicobacter pylori care pathway and highlight priorities for improving real-world management.

METHODS

This expert-informed review integrated relevant literature, international guideline documents, and structured international expert prioritisation. An initial list of implementation-related pitfalls was developed through literature review, clinical experience, and discussions among the coordinating authors and selected co-authors. Twenty-six experts from five continents participated in a structured consultation process and rated predefined pitfalls using a 5-point Likert scale. Median scores were used for relative prioritisation.

RESULTS

Treatment selection and patient management emerged as the domains most consistently prioritised by participating experts. High-impact pitfalls included empirical triple therapy in high-resistance settings, inadequate patient counselling, and empirical retreatment without escalation. Additional challenges were identified across diagnostic, treatment, and follow-up domains, highlighting persistent implementation-related barriers throughout the care pathway.

CONCLUSIONS

Recurring implementation-related challenges remain important barriers to optimal Helicobacter pylori management. Structured expert prioritisation highlights potential targets for improvement and supports further research and implementation-focused strategies to improve delivery of care.

MeSH

Helicobacter Pylori, Helicobacter, Antimicrobial Stewardship, Pharmacology, Therapeutics, Drug Resistance