Expert Consensus
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2025; 31(27): 107138
Published online Jul 21, 2025. doi: 10.3748/wjg.v31.i27.107138
First regional consensus on the management of Helicobacter pylori infection in the Middle East
Ala I Sharara, Fahad I Alsohaibani, Ahmad Alsaegh, Khalid Al Ejji, Sameer Al Awadhi, Peter Malfertheiner, Sherif A Karam, Talal Al-Taweel
Ala I Sharara, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 961, Lebanon
Fahad I Alsohaibani, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11239, Saudi Arabia
Ahmad Alsaegh, Division of Gastroenterology and Hepatology, Salmaniya Medical Complex, Manama 2904, Bahrain
Khalid Al Ejji, Ambulatory Care Center, Hamad Medical Corporation, Doha 3050, Qatar
Sameer Al Awadhi, Digestive Diseases Unit, Rashid Hospital, Dubai 4545, United Arab Emirates
Peter Malfertheiner, Department of Medical ІІ, University Hospital LMU Munich, Munich 81377, Germany
Sherif A Karam, Bachelor of Pharmaceutical Sciences, October 6 University, 6th of October City Governorate 12511, Egypt
Talal Al-Taweel, Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Ministries Area 900015, Kuwait
Co-first authors: Ala I Sharara and Fahad I Alsohaibani.
Author contributions: Sharara AI, Alsohaibaini FI, Malfertheiner P, and Karam SA revised the Delphi questionnaire to align with the specific context of the Middle East; All authors reviewed the most up-to-date literature on Helicobacter pylori; Al-Taweel TA was responsible for the final manuscript revision and submission; All authors read and approved the final manuscript.
Supported by NewBridge Pharmaceuticals.
Conflict-of-interest statement: All authors received honoraria from NewBridge Pharmaceuticals for their participation in the consensus, and Newbridge Pharmaceuticals also covered the fees for CCM, a third-party company.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Talal Al-Taweel, MD, MRCP, Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Block 1, King Khalid Bin Abdulaziz Street, Ministries Area 900015, Kuwait. taltaweel@moh.gov.kw
Received: March 16, 2025
Revised: April 16, 2025
Accepted: June 24, 2025
Published online: July 21, 2025
Processing time: 127 Days and 10 Hours
Abstract

Helicobacter pylori (H. pylori), a widespread gram-negative bacterium that colonizes the stomach, causes chronic gastritis, which may progress to peptic ulcer, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. H. pylori infection affects over 50% of people in developing countries and 10%-20% in developed countries. The Kyoto consensus classifies H. pylori gastritis as an infectious disease in the International Classification of Disease 11th Revision. The Maastricht/Florence consensus recommends treatment for all infected individuals, introducing a shift in the management strategies. The prevalence of H. pylori infection is high in the Middle East, with infection rates of 40%-70% and 85%-90% being reported among children and adults, respectively. The increasing resistance to antibiotics, including macrolides and fluoroquinolones, is a major challenge in the management of H. pylori. Clarithromycin resistance, which is associated with reduced effectiveness of standard triple therapy regimens, leading to higher rates of treatment failure, impacts the eradication rates. This emphasizes the need for routine antibiotic susceptibility testing at the national level, the use of alternative therapies, including new molecular methods, and antibiotic stewardship. An online panel of experts from the Middle East, along with an international expert, developed this consensus to provide comprehensive guidelines on the diagnosis, treatment, prevention, and role of gut microbiota in H. pylori infection, with the goal of improving clinical decision-making and reducing the impact of antibiotic resistance in the region. These guidelines are intended to support healthcare professionals involved in the diagnosis and management of H. pylori, including primary care physicians, gastroenterologists, and other specialists. They may also inform future clinical research aimed at optimizing treatment strategies and addressing regional challenges.

Keywords: Helicobacter pylori; Antibiotic resistance; Consensus guidelines; Gastric cancer; Gut microbiota

Core Tip: This expert consensus comprised comprehensive guidelines for the management of Helicobacter pylori infection in the Middle East, addressing its diagnosis, treatment, and prevention, with a focus on antibiotic resistance and gut microbiota interactions. Given the rising clarithromycin and fluoroquinolone resistance, this report emphasized the importance of antibiotic stewardship, routine susceptibility testing, and optimized first-line and rescue therapies. Incorporating regional epidemiological data, this consensus aligned with the recommendations of the Maastricht VI/Florence consensus and proposed tailored strategies to enhance eradication success and reduce the risk of gastric cancer, thereby improving the clinical outcomes and management of Helicobacter pylori infection.