The Helicobacter pylori AI-clinician harnesses artificial intelligence to personalise H. pylori treatment recommendations
Helicobacter pylori (H. pylori) is the most common carcinogenic pathogen globally and the leading cause of gastric cancer. Here, we develop a reinforcement learning-based AI Clinician system to personalise treatment selection and evaluate its ability to improve eradication success compared to clinician-prescribed therapies. The model is trained and internally validated on 38,049 patients from the retrospective European Registry on Helicobacter pylori Management (Hp-EuReg), using independent state deep Q-learning (isDQN) to recommend optimal therapies based on patient characteristics such as age, sex, antibiotic allergies, country, and pre-treatment indication. In internal validation using real-world Hp-EuReg data, AI-recommended therapies achieve a 94.1% success rate (95% CI: 93.2-95.0%) versus 88.1% (95% CI: 87.7-88.4%) for clinician-prescribed therapies not aligned with AI suggestions-an improvement of 6.0%. Results are replicated in an external validation cohort (n = 7186), confirming generalisability. The AI system identifies optimal treatment strategies in key subgroups: 65% (n = 24,923) are recommended bismuth-based therapies, and 15% (n = 5898) non-bismuth quadruple therapies. Random forest modelling identifies region and concurrent medications as patient-specific drivers of AI recommendations. With nearly half the global population likely to contract H. pylori, this approach lays the foundation for future prospective clinical validation and shows the potential of AI to support clinical decision-making, enhance outcomes, and reduce gastric cancer burden.
Authors
- Tamara Matysiak-Budnik
- Manuel Cabeza-Segura (ORCID: https://orcid.org/0000-0002-3257-1292)
- Rita Barros (ORCID: https://orcid.org/0000-0002-1667-7329)
- Míriam Cuatrecasas (ORCID: https://orcid.org/0000-0003-3063-0110)
- Glòria Fernández‐Esparrach (ORCID: https://orcid.org/0000-0002-3378-3940)
- Javier P. Gisbert (ORCID: https://orcid.org/0000-0003-2090-3445)
- Mário Jorge Dinis-Ribeiro (ORCID: https://orcid.org/0000-0003-0121-6850)
- Mārcis Leja (ORCID: https://orcid.org/0000-0002-0319-8855)
- Ana Martins (ORCID: https://orcid.org/0000-0003-3733-6619)
- Manon C.W. Spaander (ORCID: https://orcid.org/0000-0002-9103-9757)
- Fátima Carneiro (ORCID: https://orcid.org/0000-0002-1964-1006)
- K M Higgins (ORCID: https://orcid.org/0000-0003-0265-1395)
- Elena Jiménez-Martí (ORCID: https://orcid.org/0000-0002-1537-5337)
- Miguel Coimbra (ORCID: https://orcid.org/0000-0001-7501-6523)
- Rui M. Ferreira (ORCID: https://orcid.org/0000-0003-0961-2356)
- Joshua Southern (ORCID: https://orcid.org/0000-0001-9042-6504)
- Jérôme C. Martin (ORCID: https://orcid.org/0000-0003-0068-8776)
- Ivan Laponogov
- Tania Fleitas (ORCID: https://orcid.org/0000-0002-2789-9082)
- Céu Figueiredo (ORCID: https://orcid.org/0000-0001-5247-840X)
- Laimas Virginijus Jonaitis (ORCID: https://orcid.org/0000-0001-9086-3675)
- Kirill Veselkov (ORCID: https://orcid.org/0000-0002-1164-0359)
- Dennis A. Veselkov
- Juozas Kupčinskas (ORCID: https://orcid.org/0000-0002-8760-7416)
- Filipa Fontes (ORCID: https://orcid.org/0000-0001-9246-589X)
- Paulius Jonaitis (ORCID: https://orcid.org/0000-0002-4310-8543)
- Judith Honing
- Ana Miralles-Marco (ORCID: https://orcid.org/0000-0001-9720-0348)
- Olga P. Nyssen (ORCID: https://orcid.org/0000-0002-4920-9310)
- Inese Poļaka (ORCID: https://orcid.org/0000-0002-9892-7765)
- Junior Andrea Pescino
- Ana Carina Pereira
- Letícia Moreira (ORCID: https://orcid.org/0000-0002-6288-1953)
- Stefano Sedola
- Zorana Maravic
Institutions
- Lithuanian University of Health Sciences (LT)
- Universitat de València (ES)
- Universidade do Porto (PT)
- European CanCer Organisation (BE)
- Instituto de Salud Carlos III (ES)
- Erasmus MC (NL)
- Centre Hospitalier Universitaire de Nantes (FR)
- Yale University (US)
- Departament de Salut (ES)
- Instituto Português de Oncologia Francisco Gentil (PT)
- Stratec (Belgium) (BE)
- Hospital Clínic de Barcelona (ES)
- Institute for Systems Engineering and Computers (PT)
- Hospital Universitario de La Princesa (ES)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES)
- INCLIVA Health Research Institute (ES)
- Centro de Investigación Biomédica en Red de Cáncer (ES)
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto (PT)
- Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
- Imperial College London (GB)
- Universidad Autónoma de Madrid (ES)
- Universitat de Barcelona (ES)
- University of Latvia (LV)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-07-14
- DOI
- https://doi.org/10.1038/s41467-025-61329-5
- Citations
- 6
- Primary Topic
- Helicobacter pylori-related gastroenterology studies
- Type
- article
- Field-Weighted Citation Impact
- 12.04
Funders
- UK Research and Innovation
- European Commission
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
- HORIZON EUROPE Framework Programme