Molecular Characteristics of Clarithromycin- Resistant Helicobacter Pylori Strains in Russia: A Systematic Review and Meta-Analysis

Aim: to analyze the prevalence of Helicobacter pylori (H. pylori) clarithromycin resistance mutations across the Russian Federation based on molecular genetic studies.
Materials and methods. A systematic literature review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Google Scholar, and the Russian Science Citation Index (RSCI) for studies published between 1985 and 2025. Analyses focused on point mutations in the 23S rRNA gene, including A2142G (referred as A2146G), A2143G (referred as A2147G), A2144G, T2182C, and T2717C.
Results. Nine eligible studies encompassing 639 H. pylori isolates (collected between 2009 and 2024) were included. The pooled prevalence of clarithromycin resistance based on molecular genetic studies was 25.1 % (95% confidence interval: 15.7–36.0). The most prevalent mutation was A2143G (78.2 %), followed by A2142G (15.7 %) and T2717C (13.6 %). Significant heterogeneity was observed among studies (I2 = 88.6 %). No publication bias was detected via Begg’s and Egger’s tests.
Conclusion. This meta-analysis demonstrated that the pooled clarithromycin resistance rate of H. pylori strains in Russian studies conducted between 2009 and 2024 using molecular-genetic methods exceeds 25 %. Clarithromycin resistance among H. pylori strains in Russia is primarily driven by the A2143G mutation. These data are highly relevant for the design of local PCR diagnostic systems aimed at promptly identifying clarithromycin resistance in H. pylori, enabling clinicians to select personalized eradication regimens based on genetic profiles.

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