Helicobacter pylori Management in ASEAN Countries: The Bangkok II Consensus Report.

BACKGROUND AND AIM: Helicobacter pylori infection remains a major cause of gastric cancer, peptic ulcer disease, and dyspepsia-related morbidity across ASEAN. Since the first Bangkok Consensus Report in 2018, major advances have emerged in epidemiology, antimicrobial resistance, diagnostics, and eradication therapy. The Bangkok II Consensus Report aimed to provide updated evidence-based recommendations tailored to Southeast Asia.

METHODS

A multidisciplinary panel from ASEAN and international partner countries updated regional guidance through three working groups covering epidemiology and indications for treatment, diagnostic testing and confirmation of eradication, and treatment strategies. Clinical questions and statements were developed from structured evidence review. Evidence quality and recommendation strength were graded using GRADE, with consensus defined as ≥ 80% agreement.

RESULTS

Twenty-one clinical questions were addressed. The consensus emphasizes that H. pylori remains an important public health problem in ASEAN; eradication is central to gastric cancer prevention and ulcer management; diagnostic tests should be selected according to indication and local availability; 14-day bismuth quadruple therapy is the preferred empirical first-line regimen because of high clarithromycin resistance; PCAB-based regimens are promising alternatives; and posttreatment confirmation of eradication should be routinely performed.

CONCLUSIONS

The Bangkok II Consensus Report provides regionally relevant recommendations integrating antimicrobial resistance, healthcare disparities, and resource-adapted strategies across ASEAN, addressing gaps in global guidelines and supporting reduction of H. pylori-associated disease, including gastric cancer, across Southeast Asia.