Wojciech Marlicz

Was not provided for this article.

Background: Helicobacter pylori ( H. pylori ) infection causes gastritis, peptic ulcer disease, and gastric cancer. Without an effective vaccine, eradication therapy remains crucial. However, increasing antibiotic resistance compromises treatment effectiveness. Objective: To evaluate whether literature‐based resistance data could predict first‐line empirical treatment effectiveness. Methods: Resistance rates for clarithromycin, metronidazole, and levofloxacin were extracted from bibliographic reviews and estimated for three timeframes: the treatment year, the preceding year, and the last five years average. These rates (2008–2024) were matched with outcomes from the European Registry on H. pylori Management (Hp‐EuReg, WorldHpReg partner), a prospective real‐world study involving 40 countries. Analyses included Spearman's correlations, multivariate logistic regressions adjusted for demographic, clinical, and therapeutic‐related variables, bootstrap resampling stratified by eradication success, and Random Forest models. Results: Analysis included 37,659 patients receiving first‐line empirical treatment from 13 countries. Moderate negative correlations were observed between metronidazole and clarithromycin resistances for some regimens. In the regression model, including either contemporaneous or previous‐year resistance rates, clarithromycin resistance showed a negligible positive association, while metronidazole resistance was negatively associated. In regimen‐specific models, previous‐year clarithromycin resistance was positively associated with success in concomitant therapy, whereas higher five‐year mean clarithromycin resistance reduced eradication odds in quadruple clarithromycin–amoxicillin–bismuth therapy. Random Forest models identified compliance, proton‐pump inhibitor dose, regimen duration, and treatment as the strongest predictors of eradication, while resistance variables contributed minimally. Conclusion: Literature‐based resistance data are not useful for guiding real‐world first‐line H. pylori therapy, highlighting the need for individualized antibiotic susceptibility testing to obtain reliable resistance information. Trial Registration: ClinicalTrials.gov identifier: NCT02328131

European colorectal cancer screening remains largely age-defined despite changing epidemiology, heterogeneous risk, non-participation and finite colonoscopy capacity. European guidance already anticipates risk-based thresholds, intervals and test allocation; how to test these across heterogeneous health systems remains unresolved. We propose a four-decision policy and research framework, not a validated clinical protocol, addressing when screening should begin or recur, which first-line test should be offered, what result or risk trajectory should trigger escalation, and how diagnosis and treatment should be completed. Quantitative faecal immunochemical testing (FIT) should remain a principal population-based strategy and high-quality colonoscopy the confirmatory and therapeutic standard, while national programmes may differ. Previous quantitative FIT results, age, sex, family history, comorbidity and screening behaviour can be prospectively evaluated as modifiers of interval and threshold. Multitarget stool tests, blood-based cell-free DNA, microbiome or volatile-organic-compound classifiers, colon capsule endoscopy and CT colonography should address defined pathway failures rather than act as interchangeable competitors. Because evidence for risk adaptation remains modelled or observational, implementation should proceed only through prospectively governed pilots. Evaluation should prioritise sustained participation, advanced neoplasia removed, interval cancer, colonoscopy use, equity and societal cost. Risk adaptation should optimise existing workflows through prospectively validated programmatic rules, not unvetted diagnostic layers.