Tailored screening and eradication of Helicobacter pylori at a subnational level of China: multicenter observational studies in Ya'an city and a rapid meta-analysis in Sichuan province.

Helicobacter pylori infection remains a major public health concern in China, with prevalence and antimicrobial resistance patterns varying significantly at the subnational level. A multicenter observational study performed in Ya'an city showed that the pooled average prevalence of Helicobacter pylori infection was as high as 31.9% (19,058/59,791) during 2021-2023, despite significantly declining form 35.6% in 2021 to 30.4% in 2023 (P for trend < 0.0001). Moreover, men were more likely than woman to be infected in any year (p < 0.001) or any age group (p < 0.001), with the only exception being the 30-39 years age group. Additionally, the 60-69 years age group had highest prevalence among both males (38.7%) and females (33.5%), respectively. A sequential multicenter study in Ya'an (2023-2024) found high antimicrobial resistance to metronidazole (96.9%), levofloxacin (45.9%), and clarithromycin (30.2%), with 17.6% multi-drug resistance. A rapid meta-analysis on four recent studies in Sichuan province (1,203 patients) found the isolation rate of Helicobacter pylori was 70.7% (95% CI 55.8%-85.6%). The pooled estimate consistently confirmed those high resistance rates, although amoxicillin (0.4%), tetracycline (0.3%), and furazolidone (0%) maintained consistently extremely low resistance in Sichuan. Rifampicin resistance was quite diverse in Sichuan. These findings highlight the need for organized massive screening for Helicobacter pylori infection that should be encouraged in moderate-to-high prevalence regions at subnational level of China to identify individuals at high risk of gastric cancer. Both antimicrobial resistance prevalence-guided empirical eradication and susceptibility-guided individualized eradication require further investigations on effectiveness and cost-effectiveness to improve eradication of Helicobacter pylori infection.