This study aims to determine recurrence rates, identify influential factors, investigate key factors that contribute to recurrence, evaluate treatment effectiveness and to assess the efficacy of different eradication regimens and their role in reducing recurrence.

Inclusion Criteria:

• Age: 18-75 years old.
• H. pylori infection: Confirmed by endoscopy, biopsy, or non-invasive tests (e.g., urea breath test, stool antigen test).
• Symptoms: Presence of dyspepsia, peptic ulcer disease, or other H. pylori-related symptoms.
• Laboratory tests: Normal liver and kidney function, and no significant abnormalities in blood counts.

Exclusion Criteria:

• Patients receiving eradication therapy in the past taking proton pump inhibitors,, H2 blockers ,,bismuth ,, antibiotics or other medications that interfere with the result of the examination in the recent 4 weeks.
• Gastrointestinal disorders: Severe gastrointestinal disorders (e.g., gastric cancer, inflammatory bowel disease ,gastric or duodenal ulcer with current or recent bleeding , or clinical significant gastrointestinal bleeding within 4 weeks of randomization).
• Malignancies: Active or recent malignancies.
• Severe comorbidities: Unstable or severe comorbidities (e.g., heart failure, liver cirrhosis).