Helicobacter pylori is one of the most communal causes of bacterial infection in humans, but it is linked with disease in less than 20% of infected people. The majority of H. pylori‐infected persons remain colonized for life and it is possible because H. pylori is a highly flexible organism that is optimally adapted to its host. Subjects with chronic infection and genetic risk factors may be at particular hazard to development gastric disease during their live. In these individuals, the risk for developing cancer relates to the physiological and histological changes H. pylori induces in the stomach, although much remains to be understood about the pathogenesis of this relationship.

H. pylori chronic infection and its resistance to the drugs commonly used in antimicrobial therapy have been attributed not only to genetic variability, but also to ability of H. pylori to form biofilm and entry in VBNC state (dormancy) as a strategy to overcome environmental stress.

The anti-H. pylori therapeutic regimens, available at today, have several inherent problems, including both the presence of high rate of multidrug resistance which is also correlated to specific geographical areas and the significant presence of tolerant strains due to the capability to form microbial biofilm with the risk of reinfection and the high cost of antibiotic therapy.

On the basis of these evidences, novel alternatives therapies are needed. Probiotics, human derived-peptides, polysaccharides, and natural substance are successfully documented in literature. Some of these components are useful in preventing the adverse effects of antibiotics, in the modulating of the immune response, in gastroprotection, and in the general promotion of health. Moreover, the alternative therapies have been involved to maintain low bacterial levels and can be used as adjuvants of allopathic anti-H. pylori eradication therapy.

To date, research needs to be conducted to investigate the lack of correlation between in vitro susceptibility and in vivo efficacy of these approaches such as natural products, probiotics, and nutraceuticals. In fact, the important positive effects are widely revealed in in vitro detections that only in few cases are supported by in vivo studies. New research needs to be performed to demonstrate in vivo the efficacy detected in vitro.

This special issue has the goals to focus on innovative treatments identifying new bioactive substances, probiotics, and nutraceuticals for the H. pylori eradication.

The guest editors call not only for original research manuscripts as well as review manuscripts but also for rare case studies in medical microbiology in the form of case report and literature review.

Potential topics include but are not limited to the following:

• Dormancy in H. pylori
• Antibiotic resistance breakers in H. pylori treatment
• H. pylori biofilm and persistence
• New synergic natural compounds/antibiotic association in H. pylori treatment