Rapid Non-invasive Techniques for Detecting Antibiotic Resistance in Helicobacter pylori: An Update and Clinical Applications

The global prevalence of Helicobacter pylori infection remains high, posing a significant health challenge worldwide. The efficacy of anti-H. pylori antibiotic-based regimens is compromised by the increasing antibiotic resistance in H. pylori. Thus, it is important to detect antibiotic resistance in H. pylori to ensure appropriate and effective treatment strategies. Currently, conventional culture-based methods are used for detecting antibiotic resistance (so-called phenotypic resistance) in H. pylori, but these methods are tedious and time-consuming (at least 72 h) and rely on the successful culture of H. pylori. Over the past decade, emerging genotypic or molecular techniques based on polymerase chain reaction or gene sequencing of DNA extracted from cultured H. pylori cells or H. pylori-containing specimens, such as gastric biopsy, stool, or saliva, have been developed to detect antibiotic resistance (so-called genotypic resistance) in H. pylori. These methods are rapid (usually within 4 h), non- or minimally invasive, cost-effective, and highly reproducible. Moreover, they can detect heteroresistant strains, enabling tailored therapy. The development and implementation of molecular techniques have significantly improved the accuracy and speed of identifying antibiotic resistance in H. pylori, allowing for more effective and personalized treatment strategies.