First regional consensus on the management of Helicobacter pylori infection in the Middle East

Abstract

Helicobacter pylori (H. pylori), a widespread gram-negative bacterium that colonizes the stomach, causes chronic gastritis, which may progress to peptic ulcer, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. H. pylori infection affects over 50% of people in developing countries and 10%-20% in developed countries. The Kyoto consensus classifies H. pylori gastritis as an infectious disease in the International Classification of Disease 11^th Revision. The Maastricht/Florence consensus recommends treatment for all infected individuals, introducing a shift in the management strategies. The prevalence of H. pylori infection is high in the Middle East, with infection rates of 40%-70% and 85%-90% being reported among children and adults, respectively. The increasing resistance to antibiotics, including macrolides and fluoroquinolones, is a major challenge in the management of H. pylori. Clarithromycin resistance, which is associated with reduced effectiveness of standard triple therapy regimens, leading to higher rates of treatment failure, impacts the eradication rates. This emphasizes the need for routine antibiotic susceptibility testing at the national level, the use of alternative therapies, including new molecular methods, and antibiotic stewardship. An online panel of experts from the Middle East, along with an international expert, developed this consensus to provide comprehensive guidelines on the diagnosis, treatment, prevention, and role of gut microbiota in H. pylori infection, with the goal of improving clinical decision-making and reducing the impact of antibiotic resistance in the region. These guidelines are intended to support healthcare professionals involved in the diagnosis and management of H. pylori, including primary care physicians, gastroenterologists, and other specialists. They may also inform future clinical research aimed at optimizing treatment strategies and addressing regional challenges.

Keywords: Helicobacter pylori; Antibiotic resistance; Consensus guidelines; Gastric cancer; Gut microbiota

Core Tip: This expert consensus comprised comprehensive guidelines for the management of Helicobacter pylori infection in the Middle East, addressing its diagnosis, treatment, and prevention, with a focus on antibiotic resistance and gut microbiota interactions. Given the rising clarithromycin and fluoroquinolone resistance, this report emphasized the importance of antibiotic stewardship, routine susceptibility testing, and optimized first-line and rescue therapies. Incorporating regional epidemiological data, this consensus aligned with the recommendations of the Maastricht VI/Florence consensus and proposed tailored strategies to enhance eradication success and reduce the risk of gastric cancer, thereby improving the clinical outcomes and management of Helicobacter pylori infection.