Current guidelines for Helicobacter pylori treatment in East Asia 2022: Differences among China, Japan, and South Korea

Core Tip

Core Tip: Since 2000, the standard triple regimen containing clarithromycin (CAM) has been used as a legacy therapy to eradicate Helicobacter pylori (H. pylori). Resistance to CAM by H. pylori has increased to > 15% in East Asia. First-line eradication rates below 80% are strongly associated with CAM-resistant H. pylori strain emergence. H. pylori treatment guidelines in China, Japan, and South Korea were revised according to new data. In China, adding bismuth to H. pylori regimens was recommended as an empirical first-line treatment. In Japan, H. pylori treatment success increased when the potassium-competitive acid blocker (P-CAB) was introduced. In South Korea, tailored H. pylori eradication based on molecular testing for CAM resistance is used as the first-line treatment option. Dual therapy involving frequent administration of high-dose amoxicillin has shown good efficacy for H. pylori eradication in clinical trials. Furthermore, P-CABs, with their rapid and strong acid-suppressing activity, may contribute to successful H. pylori treatment in future.