Phenotypic Trends and Molecular Mechanisms of <i>Helicobacter pylori</i> Antibiotic Resistance in Bangladesh: A Scoping Review

OBJECTIVE: To comprehensively map the phenotypic prevalence, temporal trends, and molecular mechanisms of antimicrobial resistance in Helicobacter pylori isolates among patients in Bangladesh. METHOD: Scoping review conducted in accordance with the JBI methodology and reported using the PRISMA-ScR checklist. A systematic search was conducted in PubMed, MEDLINE, Scopus, and BanglaJOL to identify peer-reviewed observational studies published between 1 January 2000 and 30 April 2025. RESULTS: Ten studies were reviewed. Metronidazole resistance remained persistently high (77.5%-96.4%), while clarithromycin rates surged from ~10% to > 39%. Levofloxacin resistance also reached critical levels (up to 66.1%). In contrast, amoxicillin (< 10%) and tetracycline (< 20%) retained efficacy. Genomic analysis linked resistance primarily to 23S rRNA (A2142G, A2143G) and gyrA mutations within hpAsia2 and hpEurope lineages. CONCLUSION: The available evidence indicates a high and increasing burden of H. pylori antibiotic resistance in Bangladesh, particularly to clarithromycin, metronidazole, and levofloxacin. These findings highlight the need for updated, evidence-informed treatment strategies and expanded molecular surveillance to support effective eradication therapy.