Helicobacter pylori (H. pylori) is a Gram-negative recalcitrant oncomicrobe that infects over half of the world’s population. Infection with H. pylori is the primary cause of gastric and duodenal ulcers and gastric malignancies (Malfertheiner et al., 2023). Current guidelines suggest the test-and-treat strategy, which is the antibiotic-based eradication of H. pylori upon diagnosis (Malfertheiner et al., 2022). However, the development of antibiotic resistance mechanisms and the subsequent emergence of single-drug and multi-drug resistant H. pylori strains have made the achievement of successful eradication extremely challenging (Tshibangu-Kabamba and Yamaoka, 2021). Therefore, monitoring antibiotic resistance, elucidating resistance mechanisms and developing innovative treatment approaches have become of significant interest in this field of study. In this regard, the Research Topic of “Helicobacter pylori infection and antibiotic resistance: clinical, translational and experimental studies” appeared highly topical, presenting novel insights on the critical challenge of H. pylori antibiotic resistance and prospective treatment strategies.

Given the growing body of research around H. pylori infection, Yu et al. analyzed H. pylori research hot topics over the past decade by performing a bibliometric and visual analysis. They meticulously elaborated on the increasing trend in H. pylori-related gastric ulcer research, with China being the most prolific country in terms of publications in this area and the United States as the most influential country. A cross-sectional study by Jiang et al. demonstrated an updated situation of H. pylori antibiotic resistance in China. Although analysis of 2109 H. pylori clinical isolates presented an overall reduction of primary resistance rate over the past years, H. pylori strains are as yet highly resistant to metronidazole (67.2%), clarithromycin (36.0%), and levofloxacin (24.2%). Considering the recommendation that clarithromycin susceptibility testing should be performed prior to prescribing any clarithromycin containing H. pylori first-line therapy (Malfertheiner et al., 2022), developing simple and more rapid techniques for detecting H. pylori clarithromycin resistance seems essential (Alavifard et al., 2023).

H. pylori infection is associated with significant alterations of the gastric microbial and metabolic profile (Fakharian et al., 2022). Successful eradication of H. pylori could considerably restore the indigenous structure of the gastric microbiota; however, refractory H. pylori infection and persistent administration of various antibiotics further disturb the host microbial profile. Liu et al. demonstrated that compared to the H. pylori-positive control group, refractory H. pylori infection contributes to the enrichment of infectious disease-associated metabolic pathways in the gastric microbiota, such as energy metabolism, lipopolysaccharide biosynthesis, glutathione metabolism, and sulphur metabolism. Refractory H. pylori infection mainly featured in the colonization resistance of beneficial Lactobacillus bacteria in the stomach. Given the supplementation of various beneficial bacterial strains (probiotics), mainly Lactobacillus bacteria, as adjunctive therapies for H. pylori eradication (Nabavi-Rad et al., 2022; Nabavi-Rad et al., 2023), Kiattiweerasak et al. investigated the efficacy of L. rhamnosus and L. helveticus administration for H. pylori eradication in a double-blind, randomized, placebo-controlled study. Despite the similar eradication rates between the probiotic and placebo groups, probiotic treatment substantially reduced drug-related side effects including bloating, diarrhea, nausea, and bitter taste. Furthermore, the probiotic group presented an elevation in general health-related quality of life.

In conclusion, the published studies in this Research Topic discussed the significant importance of H. pylori antibiotic resistance and its remarkable impact on the host gastric microbial structure. These studies further elaborated the potential for microbiome-based therapeutics in improving H. pylori treatment and health-related quality of life. Nevertheless, antibiotic resistance mechanisms of H. pylori are yet to be fully elucidated and require further in-depth investigation.