Helicobacter pylori infects nearly half of the global adult population and is a leading cause of gastritis, peptic ulcers, and gastric cancer. Eradication therapies, primarily proton pump inhibitor (PPI)-based antibiotic regimens, face challenges due to antibiotic resistance and poor patient compliance. The Holistic Integrative Medicine (HIM) framework, pioneered by Prof. Daiming Fan, offers a patient-centered approach that integrates advanced medical knowledge across disciplines. The First Beijing Consensus (2018) introduced TCM principles into H. pylori management, formalizing the concept of "H. pylori-associated disease-syndrome." This second consensus builds on recent advances, further refining integrative strategies for improved clinical outcomes.
Methodology
The consensus was developed using the conference method, with two face-to-face expert meetings. A purposive sampling method selected 43 experts from 29 institutions across China, all with over 10 years of clinical experience in H. pylori management. Voting was conducted anonymously, with a 75% agreement threshold required for statement approval. The process adhered to the American College of Physicians' guideline development standards.
Part 1: Current Status and Challenges in H. pylori Management in China
This section addresses standard treatment regimens, their limitations, and the impact of antibiotic resistance. Key points include:
Statement 1: The 14-day bismuth-containing quadruple therapy is recommended as first-line, but local resistance patterns must guide antibiotic choice. TCM integration can enhance efficacy and reduce side effects.
Statement 2: High-dose dual therapy (PPI + amoxicillin) is effective and adherence-friendly, but caution is advised in vulnerable populations.
Statement 3: Declining eradication rates are primarily due to antibiotic resistance, emphasizing the need for susceptibility-guided therapy.
Statement 4: Extending treatment duration or increasing dosages beyond 14 days is not recommended due to increased adverse effects.
Statement 5: Repeated antibiotic use disrupts gut microbiota, leading to dysbiosis and gastrointestinal symptoms.
Part 2: Refractory H. pylori Infection
Defines and outlines management strategies for refractory cases:
Statements 6–8: Refractory H. pylori infection is defined as failure after ≥2 full courses of consensus-recommended therapy.
Statement 9: Principles include using low-resistance antibiotics (e.g., amoxicillin, furazolidone) and susceptibility-guided therapy.
Statement 10: Holistic individualized assessment must evaluate mucosal damage, compliance, allergies, gut dysbiosis, bacterial morphology, and host factors.
Part 3: Role of HIM in H. pylori Management
Highlines the efficacy and mechanisms of TCM in H. pylori treatment:
Statement 11: TCM exhibits bacteriostatic/bactericidal effects via multiple mechanisms, including biofilm disruption and immune modulation.
Statements 12–15: TCM combined with Western therapy improves eradication rates, reduces adverse reactions, and may shorten antibiotic course.
Statement 15: TCM-containing quadruple therapy is non-inferior to bismuth-based quadruple therapy in efficacy and superior in safety.
Part 4: Holistic Individualized Assessment/Treatment for Refractory H. pylori
Introduces the "braking" strategy and staged integrative treatment:
Statement 16: Temporary treatment pause ("braking") may restore antibiotic susceptibility by allowing bacterial metabolic readjustment.
Statement 17: Staged treatment includes pre-treatment regulation, concurrent integrative therapy, and post-treatment consolidation with TCM and probiotics.
Statement 18: Non-antibiotic agents (e.g., herbal formulas, probiotics, mucosal protectants) offer a novel treatment path by modulating the gastric microenvironment.
Part 5: Integration of TCM in Treating H. pylori-associated "Disease-Syndrome"
Details TCM syndrome differentiation and treatment schemes:
Statement 19: TCM treatment is based on "disease-syndrome" differentiation, targeting underlying patterns such as dampness-heat, deficiency, or cold-heat complexity.
Three primary syndromes are identified:
Spleen-Stomach Dampness-Heat Syndrome: Treated with Lian-Pu Decoction.
Spleen-Stomach Deficiency Syndrome: Treated with Xiangsha-Liujunzi Decoction.
Cold-Heat Complex Syndrome: Treated with Banxia Xiexin Decoction.
Discussion
The consensus advocates for a personalized, integrative approach to H. pylori management, particularly in refractory cases. It highlights the shift from excess (dampness-heat) to deficiency or cold-heat patterns in recurrent infections. Tongue diagnosis is emphasized as a key tool for syndrome differentiation. Limitations include the variable quality of TCM clinical studies and the lack of GRADE assessment, but the consensus provides a practical, real-world-oriented framework ahead of large-scale evidence.
Conclusion
The Second Beijing Consensus represents a significant advancement in the integrative management of H. pylori infection. By combining Western medical precision with TCM's holistic regulation, it offers a robust, individualized strategy to improve eradication success and patient quality of life. It is endorsed as a clinical guideline for H. pylori-associated "disease-syndrome" in China.
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The study was recently published in the Cancer Screening and Prevention .
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