To discuss the shift in H. pylori management from empiric eradication to mechanism-matched therapy in response to increasing antibiotic resistance, emphasizing the importance of aligning treatment regimens with microbial biology and antibiotic activity.
Approach:
Mechanism-Matched Therapy Framework: The review proposes a framework linking gastric niche biology, acid acclimation, adhesion, virulence signaling, immune evasion, resistance mechanisms, acid suppression, and partner-antibiotic selection.
Key Findings:
H. pylori infection is linked to serious conditions such as peptic ulcer disease and gastric cancer.
Resistance to common antibiotics has reduced the effectiveness of older empiric regimens.
Potassium-competitive acid blockers (P-CABs) and molecular testing can improve treatment outcomes by aligning regimens with microbial biology.
Vonoprazan-based regimens show improved acid suppression and efficacy in clarithromycin-resistant infections.
Molecular testing-guided therapy aligns antibiotic selection with resistance mechanisms.
Interpretation:
The review indicates that effective H. pylori treatment requires understanding the mechanisms of resistance and the biological context of the infection, moving away from one-size-fits-all approaches.
Limitations:
The review is narrative and not a systematic review, lacking PRISMA screening and unpublished data.
It does not rank every possible regimen but focuses on explaining the mechanism-matched approach.
Conclusion:
A mechanism-matched approach can aid clinicians in selecting appropriate regimens and interpreting trial results related to H. pylori treatment.
