Diagnosis and Treatment of Helicobacter pylori Infection

Annu Rev Med. 2022 Jan 27:73:183-195. doi: 10.1146/annurev-med-042220-020814.


The last 5 years have seen major shifts in defining whom to test and how to treat Helicobacter pylori infection. Peptic ulcer has changed from a chronic disease to a one-off condition, and countries with a high incidence of gastric cancer have begun implementing population-wide screening and treatment. A proactive approach to testing and treatment of H. pylori is now recommended, including outreach to family members of individuals diagnosed with active infection as well as high-risk local populations such as immigrants from high-risk countries. Increasing antimicrobial resistance has resulted in an overall decline in treatment success, causing a rethinking of the approach to development of treatment guidelines as well as the need to adopt the principles of antibiotic usage and antimicrobial stewardship. Required changes include abandoning empiric use of clarithromycin, metronidazole, and levofloxacin triple therapies. Here, we discuss these transformations and give guidance regarding testing and use of therapies that are effective when given empirically.

Keywords: Helicobacter pylori; antibiotic resistance; antimicrobial stewardship; antimicrobial therapy; gastric cancer; guidelines; molecular techniques; testing.

Publication types

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

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Clarithromycin / therapeutic use
  • Drug Therapy, Combination
  • Helicobacter Infections* / diagnosis
  • Helicobacter Infections* / drug therapy
  • Helicobacter Infections* / epidemiology
  • Helicobacter pylori*
  • Humans
  • Levofloxacin / therapeutic use
  • Metronidazole / therapeutic use


  • Anti-Bacterial Agents
  • Metronidazole
  • Levofloxacin
  • Clarithromycin