The road ahead for H. pylori - Smarter drugs and better screening
Released on : Nov. 05, 2026
Four decades after Barry Marshall and Robin Warren upended the idea that the stomach is sterile, Helicobacter pylori remains a major public health challenge. A recent New England Journal of Medicine (NEJM) review by Li, Megraud and Marshall takes stock of how far we’ve come and what’s still needed.
The good news; between 1980 and 2022, adult prevalence globally has fallen from 52.6% to 43.9%. The bad news; antibiotic resistance is climbing. Resistance to clarithromycin, levofloxacin, and metronidazole now exceeds 15% in nearly all World Health Organization (WHO) regions, which has made PPI-based triple therapy obsolete without susceptibility testing.
So, what does work? The current literature supports bismuth-based quadruple therapy and high-dose dual therapy (a PPI or P-CAB and amoxicillin) as suitable empirical options. Li et al. stress antimicrobial diligence and, where possible, susceptibility testing to support patient outcomes and mitigate the rise in antimicrobial resistance.
Despite the increase in antimicrobial resistance, the recent emergence of vonoprazan as a potent gastric acid inhibitor, and promising clinical trial results for novel antimicrobials such as rifasutenizol, offer a positive outlook for the future of H. pylori treatment.
The takeaway; H. pylori is a treatable, transmissible infection and the leading risk factor for gastric cancer, but beating it will take smarter antibiotic use.
Li, H., Megraud, F., & Marshall, B. J. (2026). Helicobacter pylori Infection — Advances, Challenges, and the Road Ahead. New England Journal of Medicine, 395(16), 1621–1633. https://doi.org/10.1056/nejmra2414530