Review Article: Implementation Challenges in Helicobacter pylori Management: Bridging Evidence and Real-World Practice.
Quach DT, Liou JM, Gisbert JP, Leung WK, Moss SF, Fallone CA, Katelaris P, Schulz C, Kayamba V, Zhou L, Vu NTH, Vilaichone RK, Miftahussurur M, Setshedi M, Riquelme A, Yadegar A, Lee YY, Ishibashi F, Jung HY, Coelho LG, Suzuki H, Lee YC, Megraud F, Mahachai V, Sugano K, Malfertheiner P
Background
Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real-world outcomes of Helicobacter pylori management remain variable. Antimicrobial resistance alone does not fully explain these discrepancies, suggesting important challenges in the implementation of evidence-based care.
Aims
To identify recurring implementation-related challenges across the Helicobacter pylori care pathway and highlight priorities for improving real-world management.
Methods
This expert-informed review integrated relevant literature, international guideline documents, and structured international expert prioritisation. An initial list of implementation-related pitfalls was developed through literature review, clinical experience, and discussions among the coordinating authors and selected co-authors. Twenty-six experts from five continents participated in a structured consultation process and rated predefined pitfalls using a 5-point Likert scale. Median scores were used for relative prioritisation.
Results
Treatment selection and patient management emerged as the domains most consistently prioritised by participating experts. High-impact pitfalls included empirical triple therapy in high-resistance settings, inadequate patient counselling, and empirical retreatment without escalation. Additional challenges were identified across diagnostic, treatment, and follow-up domains, highlighting persistent implementation-related barriers throughout the care pathway.
Conclusions
Recurring implementation-related challenges remain important barriers to optimal Helicobacter pylori management. Structured expert prioritisation highlights potential targets for improvement and supports further research and implementation-focused strategies to improve delivery of care.