The management of Helicobacter pylori infection as been readapted to recent information which resulted in new guidelines that were published in 2007 in Gut. Iron deficiency anemia with negative work up and idiopathic thrombocytopenic purpura were added to the indications for treatment while the known ones were reconfirmed. Much interest went to prevention of gastric cancer and treatment. In the prevention of gastric cancer the importance of treating infected individuals before the appearance of premalignant lesions was highlighted. The most important problem concerning treatment is the increasing resistance for clarithromycin with as a consequence a decreasing efficiency of the classical therapy. Alternatives are discussed and results of resistance for different antibiotics in Belgium are presented.