AGA Clinical Practice Update on the Management of Refractory Helicobacter pylori Infection: Expert Review

Gastroenterology. 2021 Apr;160(5):1831-1841. doi: 10.1053/j.gastro.2020.11.059. Epub 2021 Jan 29.


The purpose of this CPU Expert Review is to provide clinicians with guidance on the management of Helicobacter pylori after an initial attempt at eradication therapy fails, including best practice advice on specific regimen selection, and consideration of patient and systems factors that contribute to treatment efficacy. This Expert Review is not a formal systematic review, but is based upon a review of the literature to provide practical advice. No formal rating of the strength or quality of the evidence was carried out. Accordingly, a combination of available evidence and consensus-based expert opinion were used to develop these best practice advice statements.

Keywords: Adherence; Antibiotics; CYP2C19; Clinical Management; Gastro Neoplasm; Proton Pump Inhibitor.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Algorithms
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Benchmarking
  • Clinical Decision Rules
  • Clinical Decision-Making
  • Consensus
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Evidence-Based Medicine / standards
  • Gastroenterology / standards*
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / drug effects*
  • Helicobacter pylori / pathogenicity
  • Humans
  • Remission Induction
  • Treatment Outcome


  • Anti-Bacterial Agents