Current Status of Diagnosis, Treatment, and Prevention of Helicobacter pylori Infection in China: A 2024–2025 National Multicenter Cross-Sectional Study

Background: This study aimed to investigate the current knowledge, attitudes, and practices of Chinese physicians regarding the management of Helicobacter pylori infection through a large-scale national survey. Materials and Methods: This national, multicenter cross-sectional survey was conducted from October 2024 to May 2025 among physicians from over 2200 medical institutions across 31 provinces using an online questionnaire. The survey comprised four dimensions: basic information, knowledge, attitudes, and practices. Results were compared with the Sixth Chinese National Consensus Report on the Management of H. pylori infection and the Maastricht VI/Florence guidelines. Further, subgroup analyzes were conducted. Results: A total of 6030 valid responses were included. Knowledge: Only 27.5% of participants correctly estimated the H. pylori infection rate as 40%–50%, and 13.5% accurately understood the reinfection rate as 2%. Attitude: Overall, 93.4% of participants reported familiarity with Chinese H. pylori guidelines and consensus statements, and 84.1% supported replacing proton pump inhibitors with potassium-competitive acid blockers. Practice: Gaps were observed in recognizing indications for H. pylori eradication, including unexplained iron deficiency anemia (43.9%), primary immune thrombocytopenia (39.6%), vitamin B12 deficiency (32.3%), and H. pylori infection without countervailing factors (36.8%). The bismuth-based quadruple regimen was the most commonly selected first-line treatment (86.7%); however, 74.5% still selected the amoxicillin + clarithromycin combination, despite the high resistance rate associated with clarithromycin. The dual regimen is gradually gaining acceptance (53.9%). Subgroup analyzes: Greater adherence to guideline recommendations was observed among physicians from higher-level medical institutions, gastroenterologists, those with more years of practice, higher professional titles, and educational levels, as well as those practicing in economically developed regions. Conclusion: Chinese physicians generally follow guideline-recommended core practices for the diagnosis and treatment of H. pylori. However, notable gaps persist in understanding reinfection rates, identifying appropriate eradication indications, and selecting optimal treatment regimens. Therefore, strengthened educational interventions are warranted.