Background/Aims: Since the publication of the 2020 revision of Korean guidelines for Helicobacter pylori treatment in 2020, significant changes have occurred in the treatment landscape: clarithromycin resistance rates have risen from 17.8% to 33.3%, dual-priming oligonucleotide-based multiplex polymerase chain reaction (DPO-PCR) tailored therapy has been widely adopted in clinical practice, and potassium-competitive acid blockers (P-CABs) have become available as alternatives to proton pump inhibitors (PPIs). The Korean College of Helicobacter and Upper Gastrointestinal Research undertook a fourth revision of the evidence-based clinical practice guidelines to address these developments.
Methods: Nine key questions were formulated covering indications, diagnosis, first-line treatment, and salvage therapy. Systematic reviews with meta-analyses were conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. A total of 13 recommendations were drafted and evaluated through a modified Delphi process involving 64 experts. The agreement threshold was set at two-thirds (66.7%) of respondents selecting "completely agree" or "mostly agree" on a 6-point Likert scale. Recommendations that failed to reach consensus in the first round underwent revision and a second vote at a public hearing.
Results: Twelve of 13 recommendations achieved consensus in the first round. One recommendation regarding clarithromycin-based triple therapy required rev