Review Article: Implementation Challenges in <i>Helicobacter pylori</i> Management: Bridging Evidence and Real‐World Practice

BACKGROUND: Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real-world outcomes of Helicobacter pylori management remain variable. Antimicrobial resistance alone does not fully explain these discrepancies, suggesting important challenges in the implementation of evidence-based care. AIMS: To identify recurring implementation-related challenges across the Helicobacter pylori care pathway and highlight priorities for improving real-world management. METHODS: This expert-informed review integrated relevant literature, international guideline documents, and structured international expert prioritisation. An initial list of implementation-related pitfalls was developed through literature review, clinical experience, and discussions among the coordinating authors and selected co-authors. Twenty-six experts from five continents participated in a structured consultation process and rated predefined pitfalls using a 5-point Likert scale. Median scores were used for relative prioritisation. RESULTS: Treatment selection and patient management emerged as the domains most consistently prioritised by participating experts. High-impact pitfalls included empirical triple therapy in high-resistance settings, inadequate patient counselling, and empirical retreatment without escalation. Additional challenges were identified across diagnostic, treatment, and follow-up domains, highlighting persistent implementation-related barriers throughout the care pathway. CONCLUSIONS: Recurring implementation-related challenges remain important barriers to optimal Helicobacter pylori management. Structured expert prioritisation highlights potential targets for improvement and supports further research and implementation-focused strategies to improve delivery of care.

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Publication Details

Journal
Alimentary Pharmacology & Therapeutics
Published
2026-06-17
DOI
https://doi.org/10.1111/apt.70798
Primary Topic
Helicobacter pylori-related gastroenterology studies
Type
article
Field-Weighted Citation Impact
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article

Review Article: Implementation Challenges in Helicobacter pylori Management: Bridging Evidence and Real‐World Practice

Javier P. Gisbert, Peter Katelaris, Yi‐Chia Lee, Mashiko Setshedi et al.
Alimentary Pharmacology & Therapeutics
Helicobacter pylori-related gastroenterology studies
article

Review Article: Implementation Challenges in Helicobacter pylori Management: Bridging Evidence and Real‐World Practice

Javier P. Gisbert, Peter Katelaris, Yi‐Chia Lee, Mashiko Setshedi, Nhu Thi Hanh Vu, Violet Kayamba, Liya Zhou, Kentaro Sugano, Abbas Yadegar, Varocha Mahachai, Yeong Yeh Lee, Peter Malfertheiner, Françis Mégraud, Christian Schulz, Wai K. Leung, Steven F. Moss, Jyh‐Ming Liou, Carlo A Fallone, Muhammad Miftahussurur, Ratha‐Korn Vilaichone, Hwoon‐Yong Jung, Luiz Gonzaga Vaz Coelho, Duc Trong Quach, Fumiaki Ishibashi, Arnoldo J. Riquelme, Hidekazu Suzuki
article en

Abstract

BACKGROUND: Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real-world outcomes of Helicobacter pylori management remain variable. Antimicrobial resistance alone does not fully explain these discrepancies, suggesting important challenges in the implementation of evidence-based care. AIMS: To identify recurring implementation-related challenges across the Helicobacter pylori care pathway and highlight priorities for improving real-world management. METHODS: This expert-informed review integrated relevant literature, international guideline documents, and structured international expert prioritisation. An initial list of implementation-related pitfalls was developed through literature review, clinical experience, and discussions among the coordinating authors and selected co-authors. Twenty-six experts from five continents participated in a structured consultation process and rated predefined pitfalls using a 5-point Likert scale. Median scores were used for relative prioritisation. RESULTS: Treatment selection and patient management emerged as the domains most consistently prioritised by participating experts. High-impact pitfalls included empirical triple therapy in high-resistance settings, inadequate patient counselling, and empirical retreatment without escalation. Additional challenges were identified across diagnostic, treatment, and follow-up domains, highlighting persistent implementation-related barriers throughout the care pathway. CONCLUSIONS: Recurring implementation-related challenges remain important barriers to optimal Helicobacter pylori management. Structured expert prioritisation highlights potential targets for improvement and supports further research and implementation-focused strategies to improve delivery of care.

Alimentary Pharmacology & Therapeutics
Thammasat University (TH), Universidade Federal de Minas Gerais (BR), Ulsan College (KR), Concord Hospital (US), Tokai University (JP), Jichi Medical University (JP), Université de Bordeaux (FR), Inserm (FR), University of Cape Town (ZA), Pontificia Universidad Católica de Chile (CL), Peking University (CN), Universitas Airlangga (ID), Brown University (US), Concord Repatriation General Hospital (AU), Asan Medical Center (KR), McGill University Health Centre (CA), University of Medicine and Pharmacy at Ho Chi Minh City (VN), LMU Klinikum (DE), University of Zambia (ZM), University of Ulsan (KR), Hospital Universiti Sains Malaysia (MY), SHOWA Medical University Northern Yokohama Hospital (JP), Bordeaux Population Health (FR), Hospital Universitario de La Princesa (ES), National Taiwan University Hospital (TW), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), Hospital das Clínicas da Universidade Federal de Minas Gerais (BR), Peking University Third Hospital (CN), Instituto Nacional del Cáncer (CL), Pham Ngoc Thach Hospital (VN), Shahid Beheshti University of Medical Sciences (IR), Universidad Autónoma de Madrid (ES), Ludwig-Maximilians-Universität München (DE), University of Hong Kong (HK)
Openalex Percentile: Top 6%
Helicobacter pylori-related gastroenterology studies
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