Diagnosis of Antibiotic Resistance and Tailored Treatment Strategies for Helicobacter pylori Infection

Helicobacter pylori (H. pylori) infection is a major cause of various gastrointestinal diseases, including gastric cancer, underscoring the need for effective eradication therapy. However, the increasing prevalence of antibiotic resistance and emergence of multidrug-resistant strains have progressively reduced the efficacy of conventional empirical eradication regimens, posing a substantial clinical challenge. This review discusses the current status and major mechanisms of antibiotic resistance in H. pylori, summarizes the available diagnostic methods and their limitations, and reviews tailored treatment strategies, including susceptibility-guided therapy and antibiotic exposure history-based approaches. In addition, the roles of bismuth-containing regimens and potassium-competitive acid blockers in improving eradication efficacy are reviewed. Future management of H. pylori infections warrants a precision medicine approach that integrates regional resistance patterns and individual patient characteristics. The combined application of accurate diagnostic tools and optimized treatment strategies will help improve eradication outcomes.