Controversies in management of Helicobacter pylori infection from a U.S. perspective: population screening and treatment.

Helicobacter pylori is responsible for several gastrointestinal disorders, of which gastric cancer is the most concerning. Given the racial and ethnic disparities seen with H. pylori infection and gastric cancer in the U.S., certain populations (immigrants, non-white racial groups) remain at high-risk. While several guidelines recommend screening for H. pylori in these high-risk groups, specific guidance on how to implement population screening and the cost-effectiveness of this approach is lacking. Here we discuss several controversies including the cost-effectiveness and implementation of a population-based H. pylori screening program, empiric vs. tailored therapy based on antibiotic susceptibility, and the role of potassium-competitive acid blockers (PCABs) in H. pylori treatment. With the rapidly changing landscape of H. pylori management, here we review the latest studies and guidelines for practical clinical application.