世界上一半以上的人口感染了幽门螺杆菌；然而，患病率因地区而异，非洲发病率最高。幽门螺杆菌可能是一种与胃炎、溃疡和胃癌的发生有关的共生生物。仅幽门螺杆菌很可能不足以导致胃癌的发生，但其与该疾病相关的证据很多，因此已被国际癌症研究机构列为 1 类致癌物。在幽门螺杆菌感染期间，拟杆菌门和梭杆菌沿着口腔-肠道轴积极共存。治疗幽门螺杆菌感染所需的根除疗法也会对肠道微生物群产生有害后果，导致α多样性下降。因此，与益生菌相结合的治疗方案可能会消除抗生素治疗对肠道微生物群的负面影响。与标准治疗相比，这些与益生菌相结合的根除疗法也具有更高的根除率，并且可以减少副作用，提高患者的依从性。根除治疗不仅影响肠道微生物组，还影响口腔微生物组，其中有害细菌占主导地位。然而，有报道称幽门螺杆菌在巴雷特食管、食管腺癌、嗜酸性粒细胞性食管炎、炎症性肠病、哮喘、甚至多发性硬化症中具有保护作用。因此，应仔细考虑根除治疗，并应针对特定社区（尤其是高流行地区）制定治疗政策。应考虑补充益生菌、益生元、草药和微生物代谢物，以减少根除治疗的负面影响。在多次根除尝试失败后，应仔细权衡根除幽门螺杆菌的益处与不良反应的风险，尤其是对老年人、体弱者和对抗生素不耐受的人。© 2023。作者。

More than half of the world's population are colonized with H. pylori; however, the prevalence varies geographically with the highest incidence in Africa. H. pylori is probably a commensal organism that has been associated with the development of gastritis, ulcers, and gastric cancer. H. pylori alone is most probably not enough for the development of gastric carcinoma, but evidence for its association with the disease is high and has, therefore, been classified by the International Agency for Research on Cancer as a Class 1 carcinogen. Bacteroidetes and Fusobacteria positively coexisted during H. pylori infection along the oral-gut axis. The eradication therapy required to treat H. pylori infection can also have detrimental consequences for the gut microbiota, leading to a decreased alpha diversity. Therefore, therapy regimens integrated with probiotics may abolish the negative effects of antibiotic therapy on the gut microbiota. These eradication therapies combined with probiotics have also higher rates of eradication, when compared to standard treatments, and are associated with reduced side effects, improving the patient's compliance. The eradication therapy not only affects gut microbiome but also affects the oral microbiome with robust predominance of harmful bacteria. However, there have been reports of a protective role of H. pylori in Barrett's esophagus, esophageal adenocarcinoma, eosinophilic esophagitis, IBD, asthma, and even multiple sclerosis. Therefore, eradication therapy should be carefully considered, and test to treat policy should be tailored to specific communities especially in highly endemic areas. Supplementation of probiotics, prebiotics, herbals, and microbial metabolites to reduce the negative effects of eradication therapy should be considered. After failure of many eradication attempts, the benefits of H. pylori eradication should be carefully balanced against the risk of adverse effects especially in the elderly, persons with frailty, and intolerance to antibiotics.© 2023. The Author(s).