Response to the Letter by Dr. Parena Maheshwari Regarding Our Manuscript, "Asia-Pacific Survey on the Management of Helicobacter pylori Infection".

We appreciate the constructive comments provided by Dr. Parena Maheshwari regarding our article, "Asia-Pacific Survey on the Management of Helicobacter pylori Infection." The objective of this study was to investigate the extent of overall agreement among clinicians in the Asia-Pacific region regarding the management of H. pylori infection. Our findings highlight key challenges, including limited access to potassium-competitive acid blockers, low implementation of antibiotic susceptibility tests, and continued reliance on empirical regimens. Although vonoprazan is widely used in Japan, its adoption elsewhere remains limited due to regulatory and economic barriers. Notably, only 14.3% of clinicians reported using susceptibility-guided therapy, hindered by the decline in culture-based methods, cost issues, and limited laboratory infrastructure. We emphasize the urgent need for expanded access to molecular diagnostic tools and cost-effectiveness studies to inform future strategies. Subgroup analyses revealed regional variability; however, further studies are warranted to further examine specialty-based and intra-regional differences. Eradication therapy in pediatric and elderly populations also poses unique challenges. Concerns regarding long-term safety limit standardized protocols in children, while in elderly patients, evidence for gastric cancer prevention, particularly in those aged ≥ 80 years, remains insufficient. We are encouraged by the interest our work has generated and believe that this exchange highlights critical areas for future research, including antimicrobial resistance surveillance, individualized treatment approaches, and strengthening of health system capacities. We hope this dialogue will facilitate further research and contribute to improved H. pylori management across the Asia-Pacific region.