Helicobacter Pylori

Publication Date: May 1, 2021
Last Updated: March 14, 2022

Key statement

It is a major challenge for guidelines to achieve relevance across a wide variety of populations with varying spectrums of disease and with vastly different resources with which to deal with it.

Key statement

The major determinant of the prevalence of infection is socioeconomic status in childhood.

Key statement

As with most endemic infectious diseases, a decline in prevalence has more to do with improvements in population hygiene and sanitation than with individual, case-by-case treatment, since in most countries, only a minority of infected individuals will ever receive therapy.

Key statement

Eradication of H. pylori before the occurrence of adverse, precancerous histological changes has been shown to prevent gastric cancer and is the rationale for mass test-and-treat screening programs in young adults in countries with a high burden of disease and with sufficient resources to devote to this endeavor.

Good practice point

The decision to test for H. pylori should only be made with therapeutic intent.

Good practice point

The validation and implementation of rapid, inexpensive kit-based PCR diagnostic and antimicrobial resistance tests promises to be a major advance in management.

Good practice point

In resource-poor, high-prevalence regions in which diagnostic testing is not available, a history suggesting chronic ulcer disease—periodic upper gut pain and/or past or present melena—suggests a high likelihood of H. pylori ulcer disease and justifies empirical eradication therapy, especially in patients with no history or NSAID or aspirin use.

Key statement

The major determinant of eradication success with PPI-AC is pretreatment clarithromycin resistance.

Good practice point

Patients should always be advised that successful eradication depends on compliance with the treatment. Time should be taken to counsel the patient, explaining how to take the multidrug therapy and anticipating adverse side effects. The need to complete the treatment should be emphasized. Written or pictorial information may also aid compliance.

Recommendation Grading




Helicobacter Pylori

Authoring Organization

Publication Month/Year

May 1, 2021

Last Updated Month/Year

July 12, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Childcare center, Hospital, Outpatient

Intended Users

Physician, nurse practitioner, nurse, epidemiology infection prevention, physician assistant


Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D016480 - Helicobacter pylori


Helicobacter pylori, Clinical Practice Guideline, human bacterial pathogen, peptic ulcer, noncardia gastric, MALT lymphoma

Source Citation

Katelaris P, Hunt R, Bazzoli F, Cohen H, Fock KM, Gemilyan M, Malfertheiner P, Mégraud F, Piscoya A, Quach D, Vakil N, Vaz Coelho LG, LeMair A, Melberg J. Helicobacter pylori World Gastroenterology Organization Global Guideline. J Clin Gastroenterol. 2023 Feb 1;57(2):111-126. doi: 10.1097/MCG.0000000000001719. PMID: 36598803.