Sun Mingyao, Liu Enyu, Yang Liwen, Cao Huijuan, Han Mei
Beijing University of Chinese Medicine, Beijing, China.
Faculty of Psychology, Beijing Normal University, Beijing, China.
Syst Rev. 2025 May 9;14(1):107. doi: 10.1186/s13643-025-02816-0.
This study comprehensively analyzes the diagnostic criteria, eradication indications, treatment, and other information in the latest guidelines published by various countries around the world, so that researchers can have a systematic understanding of Helicobacter pylori and further provide a basis for clinical H. pylori diagnosis and treatment.
Nine online databases were searched to find the latest version of guidelines for H. pylori worldwide. Two researchers read the included guidelines independently and extracted the eradication indications, diagnostic criteria, and treatment in the guidelines, conducting a summary of them.
A total of 25 guidelines or consensus were included. Among all diagnostic methods for H. pylori infection, the urea breath test is widely recommended as the first choice. A total of 20 guidelines mentioned indications for H. pylori eradication. Among them, the indications with a higher proportion of recommendations were long-term use of non-steroidal anti-inflammatory drugs (including low-dose aspirin) in 90% of patients with peptic ulcer history or active peptic ulcer disease 80%; gastric mucosa-associated lymphoid tissue (MALT) lymphoma 75%. It is worth mentioning that 40% of the guidelines pointed out that, as long as H. pylori infection is confirmed, it should be eradicated. A total of 24 guidelines mentioned treatment for H. pylori. Among them, bismuth quadruple therapy (a combination of a bismuth, two antibiotics, and a proton pump inhibitor (PPI)) was the most recommended first-line therapy. Levofloxacin triple therapy (a combining of a bismuth, an antibiotic, and a PPI) was the most recommended second-line therapy.
Current global Helicobacter pylori management guidelines share foundational consensus, yet exhibit regional variations in diagnostic criteria, eradication indications, and therapeutic regimens due to context-specific epidemiological, socioeconomic, and antimicrobial resistance profiles. Clinical practice should prioritize regionally tailored approaches, integrating local guidelines while maintaining awareness of international recommendations to optimize decision-making. Moreover, health authorities responsible for guideline development must ensure timely updates based on dynamic surveillance of local resistance patterns and socioeconomic realities.
本研究全面分析了世界各国发布的最新指南中的诊断标准、根除指征、治疗方法及其他信息，以便研究人员能够系统地了解幽门螺杆菌，并进一步为临床幽门螺杆菌的诊断和治疗提供依据。
检索九个在线数据库以查找全球范围内幽门螺杆菌的最新版指南。两名研究人员独立阅读纳入的指南，并提取指南中的根除指征、诊断标准和治疗方法，对其进行总结。
共纳入25项指南或共识。在所有幽门螺杆菌感染的诊断方法中，尿素呼气试验被广泛推荐为首选。共有20项指南提及幽门螺杆菌根除指征。其中，推荐比例较高的指征为：90%有消化性溃疡病史或活动性消化性溃疡疾病患者长期使用非甾体抗炎药（包括低剂量阿司匹林）；80%；胃黏膜相关淋巴组织（MALT）淋巴瘤75%。值得一提的是，40%的指南指出，只要确诊幽门螺杆菌感染，就应予以根除。共有24项指南提及幽门螺杆菌的治疗方法。其中，铋剂四联疗法（铋剂、两种抗生素和一种质子泵抑制剂（PPI）联合使用）是最推荐的一线治疗方案。左氧氟沙星三联疗法（铋剂、一种抗生素和一种PPI联合使用）是最推荐的二线治疗方案。
当前全球幽门螺杆菌管理指南有基本共识，但由于特定背景下的流行病学、社会经济和抗菌药物耐药情况，在诊断标准、根除指征和治疗方案方面存在地区差异。临床实践应优先采用因地制宜的方法，结合当地指南，同时了解国际建议，以优化决策。此外，负责制定指南的卫生当局必须根据对当地耐药模式和社会经济现实的动态监测确保及时更新。
