Addressing the mismanagement of Helicobacter pylori in Pakistan: A call for coordinated action

Abstract

Helicobacter pylori (H. pylori) infection remains a major public health concern in Pakistan, where prevalence rates range from 50% to 80%(1), which is significantly higher than the global average, which has declined due to better hygiene, implementation of advanced diagnostic techniques, and precision therapy. This persistently high burden reflects systemic issues including poor sanitation, overcrowding, and limited access to healthcare. Despite the well-established links between H. pylori and conditions such as gastritis and peptic ulcer disease, diagnosis and treatment in Pakistan remain inconsistent and often misguided. Many patients receive empirical antibiotics without susceptibility testing, a practice that directly contradicts international “test-and-treat” guidelines(2). One unexplored aspect of this mismanagement is the “gastroenterologist’s persistence” in relying on personal experience rather than susceptibility-guided therapy. In addition to therapeutic misjudgments, diagnostic limitations also play a significant role.