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National Consensus GuidelinesGastroenterology2026advanced

First Report of National Consensus Guidelines for the Diagnosis and Treatment of Helicobacter pylori Infection in Iran.

Published by Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences · GRADE

35Recommendations

Summary

AI-generated

This first national Iranian consensus guideline provides 35 evidence-graded statements for the diagnosis and management of H. pylori infection. Utilizing the GRADE framework, it highlights non-invasive testing for young patients without alarm features, establishes 10-14 days of bismuth quadruple therapy as the first-line treatment due to high clarithromycin resistance, and provides post-treatment monitoring protocols and special considerations for renal/hepatic impairment.

Helicobacter pyloriH. pylori infectionGastroenterologyquadruple therapybismuth therapyclarithromycin resistanceurea breath teststool antigen test

Key Takeaways

1
Non-invasive testing is prioritized for young patients (<45) lacking alarm features, whereas endoscopy is reserved for high-risk patients.
2
Eradication success must be confirmed 4 or more weeks post-treatment using UBT or SAT.
3
10-14 days of bismuth quadruple therapy (BQT) is the first-line treatment to counter high (>20%) clarithromycin resistance in Iran.
4
Effective acid suppression using high-dose PPIs or P-CABs is crucial for treatment efficacy.

Key Recommendations

Diagnosis

1
Strong preference for non-invasive testing in patients under 45 without alarm features.
Diagnosis
2
Endoscopic evaluation with targeted biopsies in high-risk groups.
Diagnosis

Monitoring

3
Confirmation of eradication using urea breath test (UBT) or monoclonal stool antigen test (SAT) at ≥4 weeks post-treatment.
Monitoring

Treatment

4
A course of 10-14 days bismuth quadruple therapy (BQT) is recommended as first-line treatment, with non-bismuth concomitant therapy as an alternative.
Treatment
5
Susceptibility-guided therapy is encouraged when feasible, particularly after treatment failure.
Treatment
6
High-dose proton pump inhibitor (PPI) or potassium competitive acid blocker (P-CAB)-based acid suppression is emphasized to enhance eradication efficacy.
Treatment

Scope & Objectives

Clinical Topic

Helicobacter pylori Infection

Objectives

To provide a standardized, evidence-based framework for improving H. pylori diagnosis and management by integrating local antimicrobial resistance patterns and practical clinical considerations.

Target Patient Population

Patients with Helicobacter pylori infection

Diagnostic Criteria

Non-invasive testing for patients <45 without alarm features; endoscopic evaluation with targeted biopsies for high-risk groups.

Target Providers

GastroenterologistsPrimary Care Physicians

Patient Criteria & Setting

Therapeutic Area

Gastroenterology

Guideline Scope

DiagnosisTreatmentManagement

Special Populations

Patients under 45 years without alarm featuresHigh-risk groupsPatients with renal impairmentPatients with hepatic impairment

Evidence Grading

System: GRADE

Safety & Contraindications

Monitoring Guidance

Confirm eradication using urea breath test (UBT) or monoclonal stool antigen test (SAT) at ≥4 weeks post-treatment.

Guideline Features

Dosing informationBased on systematic reviewMultidisciplinaryDrug interactions discussed

Learning Context

Difficulty

advanced

Learning Paths

Helicobacter pyloriGastroenterologyInfectious DiseasesAntimicrobial ResistanceAntibiotic Stewardship

AI Podcast

Deep-dive audio (~10 min)

Study Guide

Structured study document

Infographic

Visual overview of key points

Slide Deck

Presentation-ready slides

First Report of National Consensus Guidelines for the Diagnosis and Treatment of — Blog

Read the full blog article

Guideline Info

SocietyNational Consensus Guidelines

Full nameFoodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences

SpecialtyGastroenterology

Year2026

Version1

Evidence systemGRADE

RegionIran

LanguageEnglish

DOI10.1111/hel.70137

Key Figures

Recommendations35

Clinical Areas

GastroenterologyInfectious Diseases

National Consensus Guidelines

Iran

Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences

All National Consensus Guidelines guidelines