Ren ZY, Liang LP, Deng Y, Yang MD, Wang ZQ, Liu L. Helicobacter pylori retreatment: When clinical guidelines meet patient reality. World J Gastroenterol 2026; 32(40): 120001 [DOI: 10.3748/wjg.120001]
Corresponding Author of This Article
Le Liu, MD, PhD, Principal Investigator, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Middle Industrial Avenue, Guangzhou 510280, Guangdong Province, China. 1402744723@smu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Ren ZY, Liang LP, Deng Y, Yang MD, Wang ZQ, Liu L. Helicobacter pylori retreatment: When clinical guidelines meet patient reality. World J Gastroenterol 2026; 32(40): 120001 [DOI: 10.3748/wjg.120001]
World J Gastroenterol. Oct 28, 2026; 32(40): 120001 Published online Oct 28, 2026. doi: 10.3748/wjg.120001
Helicobacter pylori retreatment: When clinical guidelines meet patient reality
Ze-Yan Ren, Li-Ping Liang, Ying Deng, Mu-Di Yang, Zhi-Qing Wang, Le Liu
Ze-Yan Ren, Ying Deng, Mu-Di Yang, Le Liu, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong Province, China
Li-Ping Liang, Department of Gastroenterology and Hepatology, Guangzhou Key Laboratory of Digestive Diseases, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong Province, China
Zhi-Qing Wang, Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Co-first authors: Ze-Yan Ren and Li-Ping Liang.
Co-corresponding authors: Zhi-Qing Wang and Le Liu.
Author contributions: Ren ZY and Liang LP contributed equally to this work and should be regarded as co-first authors, who were involved in the literature review, construction of the review framework and drafting of the manuscript; Deng Y and Yang MD participated in literature retrieval and critical revision of the manuscript; Wang ZQ and Liu L contributed equally to the conception of the article, supervision of manuscript preparation and final approval of the version to be published, and should be regarded as co-corresponding authors, with Liu L taking responsibility for all contact and correspondence with the journal; and all authors have read and approved the final manuscript.
AI contribution statement: The authors used generative AI tools during the manuscript preparation to refine the language, improve readability, and ensure linguistic precision. It is important to note that all scholarly ideas, interpretations, and conclusions remain the sole intellectual contribution of the human authors.
Supported by the Guangdong Basic and Applied Basic Research Foundation, No. 2023A1515111183 and No. 2026A1515010582.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Corresponding author: Le Liu, MD, PhD, Principal Investigator, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, No. 253 Middle Industrial Avenue, Guangzhou 510280, Guangdong Province, China. 1402744723@smu.edu.cn
Received: February 12, 2026 Revised: April 14, 2026 Accepted: June 2, 2026 Published online: October 28, 2026 Processing time: 213 Days and 17.9 Hours
Abstract
Helicobacter pylori eradication failure is often framed in terms of regimen performance and antimicrobial resistance. Real-world evidence, though, suggests that the clinical course after treatment failure warrants closer attention. Registry data indicate that some patients with confirmed persistent infection do not go on to receive rescue therapy. Resistance alone is unlikely to account for this gap. Other contributors may include treatment burden, prior intolerance, difficulty maintaining adherence, inconsistent risk communication, limited access to susceptibility testing, and fragmented follow-up. In this Opinion Review, recent developments of rescue therapy are discussed while emphasising that post-failure management should be considered as a care pathway rather than a prescribing event. We highlight unsolved questions regarding empirical vs susceptibility-guided retreatment, older patients, patient-centered communication, quality assessment after failure. More effective rescue regimens remain important but they will not fully address retreatment gap without structured reassessment, individual counselling, adhesion support, planned confirmation of eradication.
Core Tip: The antimicrobial resistance is not the only cause of the gap in treatment after eradication failure. The variables, which are likely to be contributing to this situation, include treatment load, past ill effects, non-compliance and break-off, communication failure or miscommunication, or break-off of follow-up. Although better rescue regimens will be required, they will not fill this gap on their own. Failure should be followed by structured reassessment, patient specific counselling, and tangible follow up.
