Consensos

Abstract
Helicobacter pylori infection remains highly prevalent, affecting approximately 40% of the global population. Individuals with infection continue to be at risk for its various clinical consequences, including chronic gastritis, peptic ulcer disease, and gastric cancer. Objective – The Brazilian Helicobacter pylori and Microbiota Study Group and the Brazilian Federation of Gastroenterology present the Fifth Brazilian Consensus on this topic, following the inaugural edition in 1995. Significant advances across various areas have emerged since the publication of the last consensus in 2018. These advances are particularly relevant to bacterial eradication, as treatment encounters mounting challenges due to rising antimicrobial resistance. Methods – For this update, five working groups were established to address: 1) epidemiology; 2) associated diseases and treatment indications; 3) diagnosis; 4) gastric cancer; and 5) treatment and microbiota. Conclusion – The groups developed 34 evidence-based recommendations to guide clinicians in managing this infection within the Brazilian population.

Introduction
Helicobacter pylori (H. pylori) infection affects the stomach of over 40% of the global population and can cause a wide spectrum of digestive diseases, such as chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric MALT lymphoma⁽¹⁾. To date, four consensus meetings on its management have been held in Brazil, namely in 1995⁽²⁾, 2004⁽³⁾, 2012⁽⁴⁾, and 2018⁽⁵⁾. The global rise in resistance to antibiotics commonly used in eradication therapy (e.g., clarithromycin, levofloxacin, and metronidazole) reduces expected treatment benefits. Coupled with the lack of new antimicrobials targeting this bacterium⁽⁶⁾, these factors raise growing concerns regarding infection management. However, significant developments have occurred in novel therapeutic regimens that use potent antisecretory agents combined with new dosing schedules, necessitating a new national consensus. Furthermore, despite the limited phenotypic and genotypic studies evaluating H. pylori characteristics in the Brazilian setting^(7,8), initial results are now available from well-structured, real-world studies encompassing all Brazilian regions. These data were obtained through the Brazilian Registry on H. pylori Management (Hp-BraReg), created in 2021 in partnership with the European Registry on H. pylori Management (Hp-EuReg), which together now constitute the World Registry on H. pylori Management (WorldHpReg)^(9,10). Although the Kyoto Consensus⁽¹¹⁾ established that every individual with an infection should be treated, the primary treatment indications have been expanded and detailed with new recommendations. Various diagnostic advances are discussed, including non-invasive, endoscopic, and histopathological methods, alongside an arsenal of molecular tests specifically designed to detect antimicrobial resistance. These advances aim to introduce an as-yet elusive antimicrobial stewardship policy into routine clinical practice. The growing role of the gastric and intestinal microbiota and the potential use of probiotics during treatment are discussed, considering current knowledge, along with different treatment strategies for primary and secondary gastric cancer prevention. Accordingly, the Brazilian Helicobacter pylori and Microbiota Study Group (Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota; NBEHPM, per its Portuguese acronym), supported by the Brazilian Federation of Gastroenterology (Federação Brasileira de Gastroenterologia; FBG), held its fifth meeting in Bento Gonçalves, Rio Grande do Sul, from October 9 to 11, 2025. A total of 26 panelists–including gastroenterologists, endoscopists, and pathologists from all five of the country’s regions–participated in the meeting. Participants were selected based on their expertise and contributions to the field.

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Acesse o documento na íntegra para conhecer todas as recomendações do V Consenso Brasileiro sobre a infecção por Helicobacter pylori.

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