The Maastricht IV/Florence Consensus Report on the management of *Helicobacter pylori* (H. pylori) infection provides updated guidelines based on the latest evidence and expert consensus. The report covers three main areas: indications and contraindications for diagnosis and treatment, diagnostic tests and treatment, and prevention of gastric cancer and other complications. Key recommendations include: 1. **Test-and-Treat Strategy**: This approach is recommended for uninvestigated dyspepsia in populations with a high prevalence of H. pylori (≥20%). Non-invasive tests like the Urea Breath Test (UBT) and stool antigen tests are preferred. The strategy is not suitable for patients with alarm symptoms or older patients. 2. **Acid and Functional Dyspepsia**: H. pylori eradication is effective in relieving dyspepsia in functional dyspepsia patients, with a long-term relief rate of about 12%. The benefit is less clear in patients with peptic ulcer disease. 3. **Gastro-oesophageal Reflux Disease (GORD)**: H. pylori status has no significant effect on GORD symptom severity, recurrence, or treatment efficacy. Eradication does not exacerbate GORD or affect treatment outcomes. 4. **NSAIDs and Aspirin**: H. pylori infection increases the risk of gastroduodenal ulcers in NSAID and low-dose aspirin users. Eradication reduces this risk and is beneficial before starting NSAID treatment, especially in patients with a history of peptic ulcer. 5. **Proton Pump Inhibitors (PPIs)**: Long-term PPI use can lead to corpus-predominant gastritis, which may accelerate atrophic gastritis. Eradication of H. pylori can prevent this progression but does not reduce the risk of gastric cancer. 6. **Intestinal Metaplasia and MALT Lymphoma**: H. pylori eradication may improve corpus function but has no effect on intestinal metaplasia. Low-grade MALT lymphoma associated with H. pylori can be cured by eradication in most cases. 7. **Extragastric Diseases**: H. pylori is linked to unexplained iron-deficiency anemia, ITP, neurological conditions, and impaired drug absorption. However, the causal links are not always clear. 8. **Virulence Factors and Host Polymorphisms**: Certain virulence factors and host genetic polymorphisms affect disease risk but are not useful for individual patient management. 9. **Diagnosis and Treatment**: The report recommends specific diagnostic tests and treatment regimens based on the prevalence of clarithromycin resistance. For low resistance, triple therapy with PPI, clarithromycin, and amoxicillin or metronidazole is preferred. For high resistance, bismuth-containing quadruple therapy or sequential treatment is recommendedThe Maastricht IV/Florence Consensus Report on the management of *Helicobacter pylori* (H. pylori) infection provides updated guidelines based on the latest evidence and expert consensus. The report covers three main areas: indications and contraindications for diagnosis and treatment, diagnostic tests and treatment, and prevention of gastric cancer and other complications. Key recommendations include: 1. **Test-and-Treat Strategy**: This approach is recommended for uninvestigated dyspepsia in populations with a high prevalence of H. pylori (≥20%). Non-invasive tests like the Urea Breath Test (UBT) and stool antigen tests are preferred. The strategy is not suitable for patients with alarm symptoms or older patients. 2. **Acid and Functional Dyspepsia**: H. pylori eradication is effective in relieving dyspepsia in functional dyspepsia patients, with a long-term relief rate of about 12%. The benefit is less clear in patients with peptic ulcer disease. 3. **Gastro-oesophageal Reflux Disease (GORD)**: H. pylori status has no significant effect on GORD symptom severity, recurrence, or treatment efficacy. Eradication does not exacerbate GORD or affect treatment outcomes. 4. **NSAIDs and Aspirin**: H. pylori infection increases the risk of gastroduodenal ulcers in NSAID and low-dose aspirin users. Eradication reduces this risk and is beneficial before starting NSAID treatment, especially in patients with a history of peptic ulcer. 5. **Proton Pump Inhibitors (PPIs)**: Long-term PPI use can lead to corpus-predominant gastritis, which may accelerate atrophic gastritis. Eradication of H. pylori can prevent this progression but does not reduce the risk of gastric cancer. 6. **Intestinal Metaplasia and MALT Lymphoma**: H. pylori eradication may improve corpus function but has no effect on intestinal metaplasia. Low-grade MALT lymphoma associated with H. pylori can be cured by eradication in most cases. 7. **Extragastric Diseases**: H. pylori is linked to unexplained iron-deficiency anemia, ITP, neurological conditions, and impaired drug absorption. However, the causal links are not always clear. 8. **Virulence Factors and Host Polymorphisms**: Certain virulence factors and host genetic polymorphisms affect disease risk but are not useful for individual patient management. 9. **Diagnosis and Treatment**: The report recommends specific diagnostic tests and treatment regimens based on the prevalence of clarithromycin resistance. For low resistance, triple therapy with PPI, clarithromycin, and amoxicillin or metronidazole is preferred. For high resistance, bismuth-containing quadruple therapy or sequential treatment is recommended