Addressing the global challenge of <i>Helicobacter pylori</i> -induced dyspepsia and peptic ulcer disease: socioeconomic, clinicopathologic, and clinico-pharmacological implications of the new treatment guidelines

Helicobacter pylori-related dyspepsia and peptic ulcers persist as major health challenges in low- and middle-income countries (LMICs) like India, Nigeria and by extension other Subsaharan nations, where high infection rates, antibiotic resistance, and inequities converge. The 2024 American College of Gastroenterology guidelines endorse Bismuth Quadruple Therapy (BQT) – a 14-day regimen combining a proton-pump inhibitor, bismuth, tetracycline, and metronidazole – and vonoprazan, a potassium-competitive acid blocker, both showing high efficacy. However, real-world adoption is hindered by prohibitive costs (especially in regions reliant on out-of-pocket spending), fragmented diagnostics, cultural distrust of biomedicine, and unregulated antibiotic use. Genetic factors, such as polymorphisms in Asian populations reducing proton-pump inhibitor effectiveness, further impede treatment. Bridging this gap demands strategies: WHO-coordinated antibiotic resistance surveillance, tiered drug pricing for LMICs, regionally tailored protocols integrating genetic testing, and community health worker-led education to address cultural barriers. Parallel policies, like community-based insurance, could enhance access to novel therapies while curbing antibiotic misuse. Without these reforms, advancements like BQT and vonoprazan risk excluding vulnerable populations. Aligning biomedical innovation with equity necessitates shifting from universal guidelines to adaptive frameworks that address genetic, socioeconomic, and cultural determinants of H. pylori outcomes globally.