Helicobacter pylori (H. pylori) infection represents one of the most prevalent bacterial infections worldwide, with a global adult prevalence of approximately 43.9%.1 It poses a substantial public health burden and is a major cause of chronic gastritis and peptic ulcer disease, as well as a major risk factor for gastric cancer. In 2018, H. pylori was estimated to account for approximately 810,000 new cancer cases worldwide, predominantly gastric cancers.2 However, the management of H. pylori infection faces substantial challenges: primary and secondary resistance rates to clarithromycin, metronidazole, and levofloxacin have reached or exceeded 15% in most World Health Organization regions, although some exceptions have been reported3; standard triple therapy may provide suboptimal eradication rates in settings with high antibiotic resistance4; and adverse drug reactions may reduce adherence and contribute to treatment failure.
In response to these pressing challenges, Professor Fulian Hu and her team have led the development of the Second Beijing Consensus on Holistic Integrative Medicine for the Management of Helicobacter pylori-associated “Disease-Syndrome”.5 The consensus aims to address critical gaps and unresolved issues in the management of refractory H. pylori infections. It offers renewed hope and practical solutions for patients who have failed conventional therapies, while also contributing to global gastric cancer prevention through improved eradication strategies.
The consensus is systematically structured around five interconnected core components that provide comprehensive clinical guidance: (1) a thorough analysis of the current challenges in H. pylori treatment in China, including rising antibiotic resistance and declining eradication rates; (2) the formal definition and classification of “refractory H. pylori infection”, accompanied by a differentiated management approach; (3) an emphasis on the unique advantages of integrative medicine, balancing antimicrobial efficacy with holistic regulation; (4) the development of a comprehensive, individualized assessment framework, incorporating gastric mucosal status, antibiotic resistance profiles, and patient compliance, to facilitate precise patient stratification; and (5) the proposal of three integrative therapeutic models grounded in syndrome differentiation and personalized treatment strategies. Throughout the consensus, a consistent emphasis is placed on the “disease–syndrome–individual” triad, reflecting the core philosophy of modern integrative medicine.
Compared to the inaugural 2018 version, this updated consensus achieves three major methodological and clinical breakthroughs: (1) a shift in focus from general patient populations to the targeted management of refractory cases, addressing a key gap in clinical practice; (2) the establishment of a systematic framework for individualized and holistic evaluation, providing a theoretical foundation for precision treatment; and (3) the introduction of a three-phase therapeutic strategy, “state–target–syndrome-guided intervention”, which integrates pathological state identification, targeted therapy, and syndrome-based regulation. This model emphasizes both symptom resolution and long-term disease modification. Collectively, the consensus refines clinical practice pathways and provides a structured framework for the application of integrative care in H. pylori management, offering new insights into personalized approaches tailored to the Chinese healthcare context.
The consensus is fundamentally grounded in the principles of holistic integrative medicine, seeking to integrate “state regulation” with “targeted therapy”. Traditional Chinese medicine (TCM) emphasizes “state regulation”, aiming to improve symptoms and clinical signs through comprehensive restoration of the body’s homeostasis and internal physiological balance. In the management of H. pylori infection, TCM seeks to enhance the body’s innate resistance mechanisms and improve overall health status through approaches such as spleen–stomach conditioning, heat-clearing and detoxification, and blood-activating and stasis-resolving methods.6 These approaches focus on optimizing the host immune response and creating an internal environment less conducive to bacterial persistence. Western medicine, by contrast, focuses on “targeted therapy”, emphasizing direct pathogen elimination through precise antimicrobial interventions designed to rapidly and effectively resolve infectious processes at the molecular level. The proposed combination of TCM and Western medicine is intended to support more individualized and systematic treatment strategies, although its comparative clinical effectiveness requires further evaluation.
One multicenter randomized controlled trial of rescue treatment reported per-protocol and intention-to-treat H. pylori eradication rates of 92.1% and 90.0%, respectively, for a 10-day furazolidone-based bismuth quadruple regimen followed by 18 days of Jinghuaweikang capsules.7 These findings support further evaluation of integrative rescue strategies, but additional high-quality trials are needed to establish their comparative efficacy and safety. However, the consensus acknowledges that some supporting studies were methodologically limited, that high-quality trials of herbal formulas remain scarce, and that GRADE was not applied because of intervention heterogeneity.5
The Second Beijing Consensus, led by Professor Hu, represents an important advancement in the evolving landscape of H. pylori management in China. It reflects a strategic shift from exclusively antibiotic-centered approaches toward more holistic, patient-oriented treatment models grounded in integrative medicine. By bridging traditional Chinese medical principles with modern biomedical practices, the consensus offers a structured framework for optimizing clinical outcomes. Notably, it outlines practical strategies to enhance treatment efficacy while reducing reliance on broad-spectrum antibiotics and contributes to the growing body of evidence supporting the integration of traditional medicine within contemporary, evidence-based healthcare systems.
The publication of this consensus represents meaningful progress in the clinical management of H. pylori. Beyond treatment methodologies alone, it synthesizes available evidence and expert recommendations concerning the potential role of integrative medicine in addressing complex clinical challenges. By harmonizing diverse medical traditions, particularly traditional Chinese and Western medicine, with contemporary scientific approaches and emerging technologies, the consensus highlights a promising direction for future innovation in patient-centered care. This consensus may encourage further clinical and research evaluation of integrative approaches to H. pylori management and may provide a reference framework for related clinical settings (Fig. 1).
Declarations
Acknowledgement
The author thanks Ruijin Hospital for the guidance and support.
Funding
None.
Conflict of interest
The author serves as an Editorial Board member of Cancer Screening and Prevention.
Authors’ contributions
DZ is the sole author of the manuscript.