H. pylori infection

Also known as: Helicobacter pylori

Also relevant to Infectious Disease

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United StatesACG/AGA/AASLD

Current

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

American College of Gastroenterology (ACG) · 2024

This ACG guideline sets out preferred eradication regimens for H. pylori in North America for both treatment-naive and previously treated patients, reflecting rising antibiotic resistance.

The guideline identifies bismuth quadruple therapy given for 14 days as the preferred option when antibiotic susceptibility is unknown. source
It advises that clarithromycin- or levofloxacin-containing salvage regimens be reserved for cases where susceptibility has been confirmed. source

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EuropeUEG/EASL

Current

Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report

European Helicobacter and Microbiota Study Group (EHMSG) · 2022 · Maastricht VI

The sixth Maastricht/Florence consensus, developed by 41 experts from 29 countries, gives European guidance on when to test for and treat H. pylori, which regimens to use, and its role in gastric cancer prevention.

The consensus treats H. pylori as an infectious disease and takes the position that infected patients should generally be offered treatment. source
It highlights growing antibiotic resistance and encourages susceptibility testing using molecular methods. source

Verify against original ↗

US vs EU key differences

Empiric first-line therapy differs: the 2024 ACG guideline makes 14-day bismuth quadruple therapy the preferred initial regimen when susceptibility is unknown, and restricts clarithromycin- or levofloxacin-containing regimens to cases with confirmed susceptibility. source
Maastricht VI keeps a resistance-threshold rule rather than a single preferred regimen: bismuth quadruple therapy is first-line where local clarithromycin and metronidazole resistance exceeds 15%, while clarithromycin-containing triple therapy remains acceptable in low-resistance areas. source
The ACG guideline names 14-day rifabutin triple therapy and potassium-competitive acid blocker (vonoprazan) dual therapy as acceptable empiric alternatives in penicillin-tolerant patients, reflecting US-specific drug approvals. source
Both documents converge on the same underlying driver: rising antibiotic resistance means susceptibility testing, including molecular methods, should guide choice of initial and salvage therapy wherever it is available. source
Version currency differs: the US treatment guideline dates to 2024, while the European Maastricht VI/Florence consensus was issued in 2022. source

What changed recently

US2017 → 20242024-09-01
Rising North American clarithromycin and levofloxacin resistance led ACG to drop those regimens as empiric first-line choices unless susceptibility testing supports them. Optimized 14-day bismuth quadruple therapy became the preferred empiric option, alongside newly endorsed rifabutin triple and vonoprazan-based dual or triple regimens.
source ↗
EUMaastricht V → Maastricht VI2022-09-01
Maastricht VI keeps most Maastricht V diagnostic indications but adds explicit third- and fourth-line eradication strategies and high-dose PPI plus amoxicillin dual therapy, and pushes molecular testing for H. pylori and its antibiotic susceptibility. It also strengthens the case for eradication as gastric cancer prevention at any adult age.
source ↗curation confidence 90%

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