The Maastricht V/Florence Consensus Report updates the management of Helicobacter pylori infection, emphasizing its role as an infectious disease. Key findings include: H. pylori gastritis is an infectious disease regardless of symptoms, and treatment is recommended for all infected individuals. A 'test-and-treat' strategy is appropriate for uninvestigated dyspepsia, especially in low H. pylori prevalence areas, but not for patients with alarm symptoms. Endoscopy is recommended for dyspeptic symptoms in low prevalence areas. H. pylori gastritis may increase or decrease acid secretion, and eradication can reverse these effects. H. pylori gastritis is a distinct entity causing dyspepsia, and eradication provides long-term relief in 10% of patients. H. pylori must be excluded before diagnosing functional dyspepsia. NSAIDs and aspirin increase ulcer risk in H. pylori-infected individuals. H. pylori testing is recommended for aspirin and NSAID users with a history of peptic ulcer. Long-term PPI use alters H. pylori gastritis patterns, but eradication heals gastritis regardless of PPI use. H. pylori is linked to unexplained iron deficiency anemia, ITP, and vitamin B12 deficiency, and should be eradicated in these cases. H. pylori is associated with various extra-gastroduodenal conditions, but causality is not proven. H. pylori eradication is first-line treatment for localized gastric MALToma. For diagnosis, UBT is the best non-invasive test, and RUT is recommended for endoscopy. Biopsies from the antrum and corpus are needed for H. pylori gastritis assessment. Immunohistochemistry can be used as an ancillary test when histochemistry fails. Clarithromycin susceptibility testing is recommended in areas with high resistance. In high clarithromycin resistance areas, bismuth quadruple or non-bismuth quadruple therapies are recommended. Treatment duration for bismuth quadruple therapy should be 14 days unless 10-day therapies are effective locally. The report provides guidelines for diagnosis, treatment, and prevention of H. pylori infection, emphasizing the importance of evidence-based recommendations and adapting to regional variations in resistance and prevalence.The Maastricht V/Florence Consensus Report updates the management of Helicobacter pylori infection, emphasizing its role as an infectious disease. Key findings include: H. pylori gastritis is an infectious disease regardless of symptoms, and treatment is recommended for all infected individuals. A 'test-and-treat' strategy is appropriate for uninvestigated dyspepsia, especially in low H. pylori prevalence areas, but not for patients with alarm symptoms. Endoscopy is recommended for dyspeptic symptoms in low prevalence areas. H. pylori gastritis may increase or decrease acid secretion, and eradication can reverse these effects. H. pylori gastritis is a distinct entity causing dyspepsia, and eradication provides long-term relief in 10% of patients. H. pylori must be excluded before diagnosing functional dyspepsia. NSAIDs and aspirin increase ulcer risk in H. pylori-infected individuals. H. pylori testing is recommended for aspirin and NSAID users with a history of peptic ulcer. Long-term PPI use alters H. pylori gastritis patterns, but eradication heals gastritis regardless of PPI use. H. pylori is linked to unexplained iron deficiency anemia, ITP, and vitamin B12 deficiency, and should be eradicated in these cases. H. pylori is associated with various extra-gastroduodenal conditions, but causality is not proven. H. pylori eradication is first-line treatment for localized gastric MALToma. For diagnosis, UBT is the best non-invasive test, and RUT is recommended for endoscopy. Biopsies from the antrum and corpus are needed for H. pylori gastritis assessment. Immunohistochemistry can be used as an ancillary test when histochemistry fails. Clarithromycin susceptibility testing is recommended in areas with high resistance. In high clarithromycin resistance areas, bismuth quadruple or non-bismuth quadruple therapies are recommended. Treatment duration for bismuth quadruple therapy should be 14 days unless 10-day therapies are effective locally. The report provides guidelines for diagnosis, treatment, and prevention of H. pylori infection, emphasizing the importance of evidence-based recommendations and adapting to regional variations in resistance and prevalence.