Helicobacter pylori Eradication: Why Recurrence Risk Should Not Dictate Treatment Decisions

Xinglan Chen, Yuanyuan Wang, Yeze Dong, Jinxia Yang, Baoyuan Xie, Dekui Zhang Lanzhou University Second Hospital, Lanzhou, Gansu, 730030, People’s Republic of ChinaCorrespondence: Dekui Zhang, Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, 730030, People’s Republic of China, Email [email protected]: Helicobacter pylori infection is unequivocally associated with the development and progression of various digestive diseases. Clinical guidelines recommend eradication therapy for all eligible patients without contraindications. However, reports of high recurrence rates in earlier studies have raised concerns among clinicians and patients regarding the necessity of treatment, which has, to some extent, hindered the timely implementation of eradication strategies. This article provides a systematic review of the issue of H. pylori recurrence. A comprehensive analysis of literature retrieved from major databases such as PubMed, Web of Science, and Google Scholar, using keywords including “Helicobacter pylori”, “recurrence”, and “reinfection”, indicates that the annual recurrence rate is significantly lower than previously thought, with modern epidemiological estimates ranging from 1.5% to 5.0%. The review further elucidates the underlying mechanisms of recurrence, identifies key modifiable risk factors, and highlights that optimizing eradication regimens and preventing intrafamilial transmission are central strategies for controlling recurrence. The conclusion emphasizes that concerns about recurrence should not preclude eradication therapy and offers a theoretical basis and practical directions for developing targeted prevention strategies in clinical practice.Keywords: Helicobacter pylori, recurrence rate, reinfection, reactivation, risk factors