Issa T, Zalloua P, Issa IA. Resistance reversal: Taiwan’s Helicobacter pylori trends defy global norms. World J Gastroenterol 2025; 31(47): 114789 [DOI: 10.3748/wjg.v31.i47.114789]
Corresponding Author of This Article
Iyad A Issa, MD, Doctor, Department of Gastroenterology and Hepatology, Harley Street Medical Center, Marina Village, Villa No. A21, Abu Dhabi 41475, United Arab Emirates. iyadissa71@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 21, 2025; 31(47): 114789 Published online Dec 21, 2025. doi: 10.3748/wjg.v31.i47.114789
Resistance reversal: Taiwan’s Helicobacter pylori trends defy global norms
Taly Issa, Pierre Zalloua, Iyad A Issa
Taly Issa, Medical School, University of Nicosia, Nicosia 24005, Cyprus
Pierre Zalloua, Department of Public Health and Epidemiology, Khalifa University, Abu Dhabi 127788, United Arab Emirates
Iyad A Issa, Department of Gastroenterology and Hepatology, Harley Street Medical Center, Abu Dhabi 41475, United Arab Emirates
Author contributions: Issa IA designed the overall concept and outline of the manuscript; Issa T and Zalloua P contributed to the discussion and design of the manuscript; Issa IA, Zalloua P and Issa T contributed to the writing, and editing the manuscript, illustrations, and review of literature; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Iyad A Issa, MD, Doctor, Department of Gastroenterology and Hepatology, Harley Street Medical Center, Marina Village, Villa No. A21, Abu Dhabi 41475, United Arab Emirates. iyadissa71@gmail.com
Received: September 28, 2025 Revised: October 5, 2025 Accepted: October 31, 2025 Published online: December 21, 2025 Processing time: 82 Days and 16.4 Hours
Abstract
Antibiotic resistance in Helicobacter pylori is reshaping eradication strategies worldwide. Analysis of 1408 treatment-naive isolates collected across Taiwan between 2019 and 2024 reveals a striking shift in resistance patterns. Tetracycline resistance, once negligible, rose to 3.5%, threatening the durability of bismuth-based quadruple therapy. Conversely, metronidazole resistance declined markedly, while clarithromycin and levofloxacin resistance remained stable at moderate levels, with levofloxacin showing significant regional variation. Emerging dual resistance involving tetracycline underscores the fragility of empiric regimens and highlights the need for culture-guided or molecular approaches. These findings reflect the dual influence of stewardship successes and environmental antibiotic pressures, while also signaling the limits of empiricism in eradication therapy. Potassium-competitive acid blockers provide a promising pharmacologic pivot, capable of enhancing antibiotic efficacy and sustaining eradication outcomes. Taiwan’s resistance profile thus offers both cautionary lessons and actionable insights for future regional and global treatment strategies.
Core Tip: This multicenter Taiwanese study reveals a sharp rise in Helicobacter pylori tetracycline resistance once negligible, now clinically relevant threatening the efficacy of bismuth-based quadruple therapy. As dual resistance emerges and empiric regimens falter, potassium-competitive acid blockers (PCABs) offer a potent pharmacologic pivot. Integrating PCABs and resistance-guided strategies may be key to sustaining eradication success in the face of evolving antimicrobial threats.
