幽门螺杆菌（Hp）是全球范围内感染率最高的胃部致病菌之一，其根除治疗能够显著降低胃癌、消化性溃疡等疾病的发生风险。然而，传统的抗生素疗法由于其广谱杀菌性，往往导致肠道菌群失调，引发腹泻、耐药性增强及免疫功能异常等不良反应。本文系统探讨了幽门螺杆菌根除治疗与肠道菌群失调之间的相互作用。一方面，尽管主流铋剂四联疗法在根除幽门螺杆菌方面效果显著，但该疗法会显著减少肠道菌群的多样性，破坏短链脂肪酸的代谢，削弱肠道屏障的保护功能。另一方面，幽门螺杆菌感染通过释放毒力因子改变胃内微环境，间接加剧了肠道菌群失调。新型疗法，如钾离子竞争性酸阻滞剂双联疗法、含有米诺环素的方案及益生菌辅助治疗，能够减轻菌群扰动，但仍然存在菌株特异性疗效差异及耐药性风险增加等问题。展望未来，需结合靶向递送技术、中西医结合以及人工智能等先进技术，制定个体化治疗策略，构建兼顾杀菌、黏膜修复与微生态平衡的精准治疗体系，以实现根除疗效与长期肠道健康的平衡。

Helicobacter pylori(Hp) is one of the most prevalent gastric pathogens globally, and its eradication effectively reduces the incidence of gastric cancer, peptic ulcers, and related diseases. However, conventional antibiotic therapies, due to their broad-spectrum bactericidal effects, disrupt gut microbiota homeostasis, leading to adverse outcomes such as diarrhea, increased antibiotic resistance, and immune dysfunction. This review systematically explores the bidirectional relationship between Hp eradication therapy and gut microbiota dysbiosis. On one hand, while mainstream bismuth-containing quadruple therapy achieves high eradication rates, it significantly reduces gut microbiota diversity, impairs short-chain fatty acid metabolic pathways, and compromises the protective function of the intestinal barrier. Conversely, Hp infection itself alters the gastric microenvironment through virulence factors, indirectly exacerbating gut microbiota imbalance. Emerging therapies, including vonoprazan-based dual therapy, minocycline-containing regimens, and probiotic adjuvant treatments, mitigate microbiota perturbation but face challenges such as strain-specific efficacy variability and heightened resistance risks. Future strategies should integrate targeted delivery systems, synergistic Chinese-Western medicine approaches, and artificial intelligence to develop personalized regimens that balance eradication efficacy, mucosal repair, and microbiota equilibrium, thereby harmonizing therapeutic outcomes with long-term gut health.