Traditional Chinese Medicine for Helicobacter pylori Infection in the Antibiotic-Resistance Era: Ethnopharmacological Evidence, Mechanisms, and Host-Pathogen Modulation.

ETHNOPHARMACOLOGICAL RELEVANCE Helicobacter pylori (H. pylori) infection remains a global health burden, and antibiotic resistance has reduced the effectiveness of standard eradication regimens. In traditional Chinese medicine (TCM), persistent infection is interpreted as retention of pathogenic factors in the spleen-stomach system. Herbal formulas are investigated as adjunctive strategies, but their clinical roles and mechanistic basis require clarification.

Aim

OF THE STUDY To develop a host-pathogen modulation framework integrating clinical evidence, antibiotic resistance and persistence mechanisms, and TCM pharmacology, while distinguishing clinically supported effects from preclinical plausibility.

Materials And Methods

This critical narrative review was based on a structured search of six databases from inception through April 2026. Evidence was synthesized without quantitative pooling.

Results

Some TCM formulas used with standard regimens were associated with improved eradication outcomes, whereas others showed similar eradication rates with possible advantages in symptom relief, tolerability, or adverse-event reduction. However, confidence in the clinical evidence remains low because most studies were small, single-center trials with heterogeneous interventions and comparators, incomplete risk-of-bias reporting, inconsistent outcome definitions, limited follow-up, and inadequate safety assessment. Preclinical studies suggest that formulas, herbs, and compounds may affect bacterial growth and colonization fitness, urease, adhesion, virulence systems, biofilm-associated tolerance, mucosal injury, inflammation, and gastric-gut microecology. Interpretation of these mechanisms is further limited by inconsistent quantitative pharmacological data, uncertain gastric exposure and pharmacokinetics, and weak linkage between experimental findings and clinical outcomes.

Conclusions

TCM should not replace standard eradication therapy. Its more defensible role is as a potential host-pathogen modulatory strategy with adjunctive, supportive, and mucosa-protective value. The current clinical findings should be regarded as preliminary rather than confirmatory. Rigorous multicenter trials, standardized interventions, quantitative pharmacology, pharmacokinetic validation, and mechanism-linked clinical studies are required.