A decreased incidence in Helicobacter pylori infection has been globally reported but many countries still struggle with a high prevalence of paediatric H. pylori infection and its consequences.

New insights around childhood H. pylori infection led to updated perspectives on growth, blood and immune disorders. Databases from high incidence countries show us how empowerment in eradication can be invested. Underdeveloped countries seem to pay attention to their local practice and recognise risk factors in their specific population.

Extra-gastric diseases such as growth and anaemia have newly published data supporting a causal relation between H. pylori infection and short stature and as well as immune function.

Quadruple therapy including bismuth has been described as the most successful eradication therapy compared to conventional triple therapy. Gut microbiome changes after therapy seem to be limited to a short-term period after eradication.

Important reflection focused on the adherence to guidelines in clinical practice, due to COVID-19 needed adaptation facing the pandemic threat or by divergent standards of care for years in regional settings after the implementation of clinical guidelines.

This review covers the relevant published literature from April 2021 to March 2022, where the crosstalk between old and new issues took place.