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New ACG guidelines prioritize 14-day BQT as the preferred first-line treatment for Helicobacter pylori infection and reinforce universal post-treatment confirmation of eradication.
Helicobacter pylori (H. pylori) infection remains one of the most common chronic bacterial infections worldwide and is a major contributor to dyspepsia, peptic ulcer disease, and gastric cancer. Growing antibiotic resistance and evolving treatment outcomes continue to challenge effective disease management, underscoring the need for updated, evidence-based clinical guidance. To address these challenges, the American College of Gastroenterology (ACG) developed a comprehensive clinical practice guideline to evaluate current evidence and provide updated recommendations for the diagnosis, treatment, and post-treatment management of H. pylori infection in North America.
The guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Experts systematically reviewed available evidence across 11 Population, Intervention, Comparison, and Outcome (PICO) questions related to H. pylori management. Recommendations were formulated based on evidence quality and clinical relevance, while expert consensus was employed to develop additional key concepts in areas where robust evidence was limited.
The guideline established several important recommendations for the management of H. pylori infection:
Several knowledge gaps were identified, leading to recommendations for future research aimed at improving treatment outcomes and antimicrobial stewardship. Overall, the recommendations promoted evidence-based treatment selection, emphasized eradication confirmation, and encouraged more personalized management approaches in patients with H. pylori infection.
The updated ACG guideline represented a significant advancement in the management of H. pylori infection by aligning treatment recommendations with contemporary evidence and emerging antimicrobial resistance patterns. By prioritizing effective first-line regimens, advocating routine confirmation of eradication, and supporting susceptibility-guided therapy when appropriate, the recommendations provided clinicians with a practical framework for improving treatment success and reducing the long-term burden of H. pylori-associated disease.
The American Journal of Gastroenterology
ACG Clinical Guideline: Treatment of Helicobacter pylori Infection
William D Chey et al.
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