Global Trend on Machine Learning in Helicobacter within One Decade: A Scientometric Study

Purpose This study aims to create a science map, provide structural analysis, investigate evolution, and identify new trends in Helicobacter pylori (H. pylori) research articles. Methods All Helicobacter publications were gathered from the Web of Science (WoS) database from August 2010 to 2021. The data were required for bibliometric analysis. The bibliometric analysis was performed with Bibliometrix R Tool. Bibliometric data were analyzed using the Bibliometrix Biblioshiny R-package software. Results A total of 17,413 articles were reviewed and analyzed, with descriptive characteristics of the H. pylori literature included. In journals, 21,102 keywords plus and 20,490 author keywords were reported. These articles were also written by 56,106 different authors, with 262 being single-author articles. Most authors' abstracts, titles, and keywords included “Helicobacter-pylori.” Since 2010, the total number of H. pylori-related publications has been decreasing. Gut, PLOS ONE, and Gastroenterology are the most influential H. pylori journals, according to source impact. China, the United States, and Japan are the countries with most affiliations and subjects. In addition, Seoul National University has published the most articles about H. pylori. According to the cloud word plot, the authors' most frequently used keywords are gastric cancer (GC), H. pylori, gastritis, eradication, and inflammation. “Helicobacter pylori” and “infection” have the steepest slopes in terms of the upward trend of words used in articles from 2010 to 2021. Subjects such as GC, intestinal metaplasia, epidemiology, peptic ulcer, eradication, and clarithromycin are included in the diagram's motor theme section, according to strategic diagrams. According to the thematic evolution map, topics such as Helicobacter pylori infection, B-cell lymphoma, CagA, Helicobacter pylori, and infection were largely discussed between 2010 and 2015. From 2016 to 2021, the top topics covered included Helicobacter pylori, H. pylori infection, and infection.


Introduction
Helicobacter pylori (H. pylori) is a spiral gram-negative bacterium located on the epithelial surface of the stomach [1]. Te prevalence of H. pylori infection ranges from 20% to 50% in developed countries to more than 80% in developing countries [2]. Although the vast majority of infected individuals will never develop H. pylori-related symptoms [3], an enormous amount of evidence suggests that H. pylori is always a pathogen that all populations would be better of without and that it should therefore be eradicated [4].
H. pylori infection risk factors include low socioeconomic status [5], an increase in the number of siblings [6], and having an infected parent, especially an infected mother [7]. Tis infection is typically contracted in the early years of life and lasts indefnitely unless treated, causing chronic infammation of the underlying mucosa [8]. Terefore, H. pylori infection has been associated with gastric and duodenal ulcers (1-10% of infected patients), gastric cancer (GC) (0.1-3%), and gastric mucosa-associated lymphoid tissue lymphoma (less than 0.01%) [9]. H. pylori is a known carcinogen for the development of GC, as the second leading cause of cancer-related deaths worldwide [10]. Furthermore, there is evidence linking H. pylori to the etiology of otherwise unexplained iron defciency anemia, idiopathic thrombocytopenic purpura (ITP), and vitamin B12 defciency. Under these circumstances, H. pylori needs to be identifed and eradicated [9][10][11].
Based on the evidence, it is estimated that the relationship between this microbe and its host dates back 100,000 years [12]. In the past fve years, numerous studies have investigated H. pylori as an important pathogen. According to published data, the majority of these studies focused on six broad categories: genetics, enzymes, antioxidants, microbial community, nanoparticles, and amino acids. Genetic diversity is one of the most important factors that contribute to the survival and virulence of H. pylori [13]. Multiple enzymes, including urease, catalase, lipase, phospholipase, and protease, are used by H. pylori to ensure microbial virulence [14]. Several medicinal plants and chemicals have been studied as antioxidants, which inhibit the oxidation reaction and the production of free radicals in the body, thereby preventing the damaging impacts of H. pylori [15,16]. Te microbial community as another infuential factor during the last 5-year studies indicates that H. pylori can induce changes in microbial populations in favor of infection and pathogenicity progression [17]. Nanoparticles, which are small particles ranging in size from 1 to 100 nanometers [18], have been identifed as one of the H. pylori treatment options [19]. Finally, amino acids, which have been discussed in fewer articles, play a dual role in H. pylori infection. Some of amino acids, such as alanine, can contribute to infection progression, while others, such as L-tyrosine, have an inhibitory efect [20].

Literature Review
Mahala and Singh analyzed research output in Indian universities by retrieving 26,173 documents, including conference proceedings, journal articles, and review papers. It was discovered that science research outputs have been steadily increasing, with the University of Delhi (DU) having the most publications. Furthermore, multiauthored articles were found to have a higher research impact because they were cited more frequently than single-authored papers. Te United States, South Korea, and Germany collaborated most with Indian universities, such as Anna University, Indian Institute of Technology, and the Center for Scientifc and Industrial Research (CSIR) of India. Tis study also revealed the recent growth trend of top Indian universities. Te fndings could be used to help determine where to focus eforts in order to increase scientifc research output even more [21].
In a study by Suk et al.,37,451 publications were displayed during the 18-year study period, including 19,080 articles, 10,396 conference abstracts, 2,625 reviews, 1,943 proceedings, and 1,866 letters. In the Science Citation Index, 1,727 journals were listed in 122 subject categories. Te felds of clinical gastroenterology, hepatology, microbiology, pharmacology, and pharmacy have conducted the majority of H. pylori research, and the G7 developed countries produced the majority of the world's total output. Te term "ulcer" remains a hotspot in H. pylori research, and the use of "gastric cancer" has increased over the 18-year study period [22]. Suk  Finally, the fndings revealed that the H. pylori study's three main research foci were gastric cancer, low-grade gastric lymphoma, and the CagA gene [23].
In their scientometric study on gastritis in G20 countries, Amanullah and Rajeswari used data obtained from the Web of Science and analyzed them using HistCite and VOSviewer. Te results show that Malfertheiner, Graham, and Megraud are their three most cited authors, having been cited 4,933, 4,588, and 4,129 times, respectively. According to journal analysis, the Gut journal (8,320 citations) is the most cited, followed by World Journal of Gastroenterology (6,603), Proceedings of the National Academy of Sciences of the United States of America (4,050), Infection and Immunity, Gastroenterology (3,749), and Journal of Immunology (3,613). In accordance with an institutional citation analysis, Vanderbilt University is the most cited (5952 citations), followed by Baylor College of Medicine (5,061), Magdeburg University (3,953), Hokkaido University (3,264), Aberdeen University (3,212), INSERM (2,722), and Tokyo University (2,594) [24].
Moradi et al. conducted a case study of the D8 countries to assess studies on health science based on the quadruple helix model using content analysis as well as altmetric and scientometric indicators from the Altmetrics.com and WOS databases. Te fndings revealed that the majority of interactions occurred in the innovation and knowledge spaces, with quadruple imbalances observed in the countries studied. Furthermore, certain interactions occurred across all social networks, demonstrating that users in the D8 countries are concerned with health-related issues. Clinical sciences had the most interaction across all four spaces. In the current approach, this model has never been used with altmetric data [25].
Sahoo and Pandey showed that 53.57% (8,195) of the investigated research documents were published on openaccess platforms. In analyzing the researchers' journal preferences, Journal of Virology was identifed as the most preferred journal, producing approximately 5.48% (839) of the articles. Te research output was found to be dominated by China and the United States, with the University of Hong Kong producing the highest percentage of research papers (3.58%, n � 547). Te majority of research documents were published in medicine (49.70%), followed by immunology and microbiology (35.72%). Biochemistry, genetics, and molecular biology were the other preferred domains (22.32%). Since January 2020, an unprecedented number of publications have been devoted to COVID-19, and there has been a signifcant increase in research fndings in this area [26].
Mariam et al. carried out a meta-analysis with a scientometric review to investigate the evolution of research on the safety and health of women in the construction industry. Tey attempted to identify research trends and patterns, as well as hazards and workplace stressors faced by women working in the construction industry. Teir fndings revealed fve major recurring themes: workplace psychological health, HIV/AIDS and construction work, occupational health and safety injuries, gender inclusivity and sexism in construction, and gender-specifc health and safety analysis. Te main dangers that women faced in the construction industry were biological in nature. Teir results also revealed that research on women's health and safety is progressing slowly, with the United States, Japan, Australia, and South Africa leading the way in terms of research development [27].
Today, machine learning assists scientists in numerous felds of study [28]. Also, in medicine, scientifc topics can be investigated using co-occurrence analysis, and their relationship can be gleaned directly from the subject content. R was created by statisticians for statisticians, but any developer can predict the same trend by looking at its syntax. R is the right choice for anyone who wants to gain a better understanding of the underlying details and be innovative because it contains mathematical computations involved in machine learning, which are derived from statistics. R is also the best choice for analyzing a corpus of texts by deconstructing paragraphs into words or phrases to identify patterns. H. pylori is one of the medical research topics of interest. Because of the importance of H. pylori infection in terms of patient quality of life and complications, this study aims to conduct bibliometrics of H. pylori infection and its related components in the literature. Terefore, the purpose of this research is to generate a science map, ofer a structural analysis, explore evolution, and identify new trends regarding H. pylori treatment and prevention in the published research between 2010 and 2021.
H. pylori data were collected from the WoS using a search strategy that spanned ten years, from August 2010 to 2021. Te information has been obtained using Boolean operators based on keywords, titles, and abstracts. However, nonrelated conference abstracts, books, and articles were excluded. Since the majority of the terms in this feld were in English, the search strategy was restricted to articles published in English in all WoS databases. Te data required for bibliometric analysis, such as authors, year of publication, journal, afliation, country of origin, organizations, fnancing organization, and keywords, were extracted as a plain text fle from the database, with no ethical validation required ( Figure 1).

Bibliometric
Analysis. Te bibliometric analysis was performed with Bibliometrix R Tool [29]. Bibliometric data were analyzed using the Bibliometrix Biblioshiny R-package software (https://bibliometrix.org/biblioshiny.html) [30]. Te R tool is an open-source tool for scientifc map analysis and plotting. It is widely regarded as the most powerful and adaptable open-source statistical software [31]. Tis bibliometric analysis aimed to visualize, identify, and describe data based on [32]: (1) Annual scientifc production and year of publication (2) Sources and documents published on the subject (3) Authors and institutions that work in this feld (4) Countries that have played a role in publishing these articles (5) Keywords, subjects, and themes in this feld

Data Analysis.
Coword analysis was used to analyze keyword co-occurrences as well as identify relationships and interactions between research topics and emerging research trends. Also, the content analysis technique was used to map the strength of association between keywords in textual data [33]. Tis technique measures the co-occurrence of keywords to examine content in the textual data.

Main Information.
A total of 17,413 articles were reviewed and analyzed ( Figure 1), with descriptive characteristics of the articles published in the H. pylori literature shown in Table 1. In this descriptive analysis, 21,102 keywords plus and 20,490 authors keywords were reported in journals. Tese articles were also published by 56,106 diferent authors, of which 262 were single-author articles. Te co-authorship rate was reported to be 3.27, indicating a relatively high level of collaboration. Te number of documents per author was reported to be 0.31, with nearly all three authors contributing to an article (Table 1).

Annual Scientifc Productions.
Te annual scientifc production on H. pylori infection is shown in Figure 2. As can be seen, the number of articles published increased from Global Health, Epidemiology and Genomics 2010 to 2011, followed by a decrease from 2011 to 2017. Tere is a dramatic decline in the number of published articles in 2017, possibly due to the use of more efective drug regimens, higher success rates in treating H. pylori infection, and reduced complications. In contrast, the number of articles published in 2018 increased, indicating that researchers focused on topics such as drug resistance as well as basic issues such as genetics, enzymatic discussions, antioxidant activity, microbial connections, and amino acids [34]. Finally, the number of H. pylori-related articles has been declining since 2019.

Core Journals on the Infuential Aspects of Helicobacter pylori.
Te source impact and the Bradford law were both used to determine the original and infuential journals contributing to the H. pylori literature.
Te ranking of journals is shown in Table 2 based on the h-, m-, and g-indices, total citations (TCs), and the number of publications (NP). Based on these criteria, Gut, PLOS ONE, and Gastroenterology are the most infuential journals contributing to the H. pylori literature.
Bradford's law of variance is the law of diminishing returns and variance. Bradford wrote that he enacted the act in 1948 and asserted that, for certain subjects, "there are some very prolifc journals, many more modest producers, and many more in ever-decreasing production." Te Bradford law divides journals into three zones. For each issue or topic, the top one-third (zone 1 or core) represents the journals that are most frequently cited in the literature on that topic and are therefore most likely to be of interest to researchers in the feld. Te middle third (zone 2) contains journals with an average citation frequency, whereas the bottom third (zone 3 or tail) contains journals that are rarely cited and of marginal importance to the feld. Zone 1 contains the most important journals in this feld. Tere are 43 journals in zone 1, and the remaining journals are located in zones 2 and 3. Te top twenty journals in zone 1 are shown in Table 3.

A Tree-Field Plot of Helicobacter pylori Publications.
A three-fold analysis of H. pylori publications is shown in Figure 3 in terms of afliation, country, and keyword plus. Rectangles of various colors were used to explain the diagram's relevant elements. Te height of the rectangles was determined by the sum of the relations originating between the elements that the rectangle represented (one of the elements: authors, countries, and keywords).     h-index: the number of articles from that journal that has at least the same number of cited and referenced articles, g-index: gives more weight to highly cited journals, m-index: takes into account years since the frst publication and is more relevant to an earlier career journal than the h-index, TC: times cited, NP: number of publications, and PY-start: year start.

Global Health, Epidemiology and Genomics
China has most collaborations with most afliations and subjects, followed by the United States and Japan. H. pylori subjects have been considered in most countries and afliations. Moreover, Seoul National University has published the highest number of articles on H. pylori. So, Seoul National University and China are the infuential university and country for H. pylori, respectively. Table 4 lists the top H. pylori articles by total citations published between 2010 and 2021. Te following is a summary of the core H. pylori articles:

Core Articles of Helicobacter pylori from 2010 to 2021.
Te epidemiological study conducted by Siegel et al. addressed the impact of eliminating socioeconomic and racial disparities on premature cancer-related deaths, with a focus on death rates, cancer incidence over a 12-year period in the United States, and mortality for any reason was standardized by age. According to the fndings, the type of cancer and gender can predict the annual incidence of cancer and cancer-related deaths to some extent. Furthermore, the occurrence of cancer types was predicted by gender, race, and the state in which the person lived [35].
Furthermore, Sharma et al. investigated the primary transcriptome of the major human pathogen H. pylori, as well as the H. pylori genome sequence, and proposed a new model for mapping and annotating the pathogen's initial transcription [36].
Te study by Arnold et al. looked at the global incidence of esophageal cancer by a histological subtype in 2012, as well as the rate and pattern of gastric cancer incidence. According to the fndings, men are three times more likely than women to develop GC and noncardiac cancer of the stomach which is about 2.1 times more likely than GC [37].
Te study by Jakobsson et al. evaluated the short-and long-term efects of clarithromycin and metronidazole, a common treatment regimen for H. pylori, on the internal microbiota in the throat and lower intestine. Signifcant changes in bacterial diversity were observed one week after antibiotic treatment in all treated individuals at both sites. Furthermore, actinobacteria in the throat and feces were signifcantly reduced immediately after treatment. Although microbiota diversity eventually improved in pretreatment  conditions, the microbiota remained abnormal in some cases for up to four years after treatment. Furthermore, high levels of the macrolide resistance gene erm(B) were found four years after treatment, indicating that antibiotic resistance may persist for longer than previously thought. Tis highlights the importance of limited use of antibiotics to prevent further treatment failure and the possible spread of antibiotic resistance [38]. Moreover, Plummer et al. conducted a synthetic study in 2012 to investigate the global burden of cancers attributable to infections and the efect of infectious agents on the incidence of various cancers. According to the fndings, infectious agents cause about 15% of all cancers each year, with H. pylori being the most common microbial agent. As a result, detecting and eliminating some infectious agents will be a highly efective method of lowering cancer incidence [39].
Finally, Graham studied H. pylori treatment for increasing antibiotic resistance and highlighted the degree of antibiotic resistance to the three-drug regimen, recommending the use of the most efective enzymes in each region with a success rate of more than 90%, based on the prevalence of regional diferences [40].

Most Frequent Words in Helicobacter pylori Publications.
Te most common words in H. pylori publications are divided into four categories: keywords plus, titles, abstracts, and author's keywords (Tables 5 and 6). As shown in Table 5, the most common occurrences of keyword plus are Helicobacter-pylori, infection, Helicobacter-pylori infection, and expression and the most frequent occurrences words in the titles are Helicobacter, pylori, gastric, and cancer. Furthermore, according to Table 6, the most commonly used words in authors' keywords are Helicobacter, gastric cancer, pylori, and gastritis and the most frequently identifed words in abstracts are pylori, gastric, patients, and infection. According to these fndings, the majority of authors used the term Helicobacter-pylori in their abstracts, titles, and keywords. Te words with a high co-occurrence in the titles, abstracts, and keywords, on the other hand, demonstrate the distinction between the use of words and the signifcance of the subjects addressed in these sections. Te use of generic words in titles, abstracts, and keywords demonstrates the general importance of these understudied topics.
As shown in Table 5, H. pylori infection can lead to some complications. Moreover, the only place where this microbe colonizes is the stomach as indicated by the term gastric. H. pylori-induced gastritis is the most common gastrointestinal (GI) infection [41]. Te association between H. pylori infection and GC is well known [42]. Eradication of H. pylori infection in asymptomatic patients is quite efective in preventing gastric cancer [43]. H. pylori requires the expression of several genes or infammation markers in order to be pathogenic. In some patients, risk factors contribute to the symptoms or complications associated with H. pylori infection. Tese risk factors are more prevalent in some patients. Figure 4 shows a cloud word plot based on the most frequently used keywords by the authors. Gastric cancer, H. pylori, gastritis, eradication, and infammation are the most frequently used terms.

Word Cloud in Helicobacter pylori from 2010 to 2021.
GC is the ffth most common cancer in the world [44] and the second leading cause of cancer-related death [45]. GC is caused by long-term infammation of the stomach [46]. H. pylori infection is the most important risk factor for GC. People who are infected with H. pylori have a much higher incidence of GC than those who are not [47]. H. pylori infection leads to many changes in the gastric mucosa, which can lead to complications such as infammation, immune dysfunction and apoptosis, mitochondrial changes, aging, and gastric dysbacteriosis [48]. H. pylori eradication improves the majority of GI symptoms, such as indigestion, abdominal pain, bloating, and decreasing the risk of bleeding in patients with a history of GI bleeding [49,50], thereby enhancing the quality of life [50]. Figure 5 illustrates the upward trend of the words used in the articles from 2010 to 2021. As seen in the diagram, the terms Helicobacter pylori and infection have the steepest slopes, while the other terms have a less steep slope.

Tematic Map of Helicobacter pylori from 2010 to 2021.
Strategic diagrams can be used to assess the signifcance and progression of subjects. Figure 6 depicts a strategic diagram of H. pylori disease, in which the x-axis represents density and the y-axis represents the thematic center and divides the diagram into four parts.
Te subjects in the bottom left quarters are emerging and declining subjects; new subjects may appear or disappear in this section. Te subjects depicted in the lower right quarter are the main traverse subjects, with low density and high centrality, indicating that they have been studied extensively. Furthermore, the subjects in the upper left quarter are denser and less centrality. Tese topics are well developed but distinct. Te subjects shown in the upper right quarter have high density and high centrality. Tese subjects are developed and essential. Tis map shows the subjects over a ten-year period. As can be seen, the theme engine and the emerging section have produced the majority of the subjects.
Te emerging section of the diagram contains subjects such as H. pylori, gastritis, and CagA. In addition, infammation, stomach, and helicobacter are all found in the center. Furthermore, subjects such as gastric cancer, intestinal metaplasia, epidemiology, peptic ulcer, eradication, and clarithromycin are included in the diagram's motor theme section. In recent years, clarithromycin triple or drug therapy has been one of the recommended treatment regimens for H. pylori infection [51]. H. pylori infection is the most important risk factor for intestinal metaplasia, a precancerous stage of GC. Eradication of H. pylori can improve intestinal metaplasia and thus prevent GC [52]. Since the recent COVID-19 outbreak, a large number of trials have been stopped at an early stage due to limited patient access and the impossibility of feasibility studies, rather than for Global Health, Epidemiology and Genomics 7 statistical reasons. As a result, there has been a growing trend in recent years to conduct misanalysis reviews of previous studies' results in the literature [53]. Despite a decrease in the prevalence of H. pylori infection and a decrease in duodenal ulcers in recent years, epidemiological studies show that the number of gastric ulcers and GC continues to rise [54]. Numerous studies have found an association between H. pylori infection and obesity [55], but some studies have not found an association between H. pylori infection and childhood obesity or overweight [56].
H. pylori infection can be diagnosed using a number of diferent approaches. We can classify these techniques as either invasive or noninvasive. In cases that H. pylori infection has been treated or the rate of virus colonization is low, immunohistochemistry is a highly sensitive method for diagnosing the infection [57]. To achieve homeostasis in the gastric epithelium, production and death of epithelial cells must be in equilibrium. Numerous studies have demonstrated that infection with H. pylori causes limited cell death (apoptosis) [58] or a greater increase in cell proliferation compared to cell death, and this is one of the pathophysiologies that increase the risk of GC [59].
In addition, due to the increasing resistance of antibiotics to treat H. pylori infection, day-by-day interest in new treatment regimens with greater efcacy and fewer side efects has grown. One of these techniques is the incorporation of probiotics into treatment regimens, which increases treatment efcacy and decreases treatment-related side efects [60]. Also, all of terms are explained in nodes of Figure 6 which are shown in Table 7.    Multiple studies have demonstrated that H. pylori eradication can result in regression of primary gastric lymphoma [40]. Due to recent improvements in the diagnostic methods of gastric lymphoma by endoscopy and endosonography and efective treatment regimens for H. pylori, the number of articles on lymphoma has decreased.
Numerous studies have demonstrated that infection with the CagA strain of H. pylori increases the risk of complications such as peptic ulcer disease and GC [62,63]. Given the defnitive recognition of the pathogenicity of CagA species and the fact that H. pylori treatment is unrelated to the bacterial species, studies on this species have declined in recent years. In addition, each term is defned in the nodes of Figure 7 which are shown in Table 8.

Discussion
Tis study analyzed the authors, countries, afliation, keywords, key research streams, and themes addressed in Helicobacter-related articles published in the WoS database between 2010 and 2021 using bibliometric and visualization techniques. During this time, 56,106 authors published 17,413 articles on Helicobacter in 2,365 scientifc journals. Te co-authorship rate was reported to be 3.27, indicating a relatively high level of collaboration. Te documents per author were reported to be 0.31, with almost all three authors involved in writing an article. Gut, PLOS ONE, and Gastroenterology are the most important journals contributing to the H. pylori literature. Tis study's data illustrated the progression of studies in recent years and the varying concentrations of evaluations in diferent years.
H. pylori infection is very common, possibly afecting more than half of the world's population [64]. Person-toperson transmission is the most common mode of H. pylori infection transmission. Other routes of transmission, such as the consumption of contaminated water or food, may also be involved in the disease's transmission [65]. Tis infection and its symptoms can reduce the quality of life in patients [50]. Besides, its complications may lead to mortality and shortening of life expectancy in patients. Te bacterium's changing epidemiology has been associated with a drop in peptic ulcer disease and GC [66].
Tere are several methods for diagnosing H. pylori infection, which are classifed as invasive or noninvasive tests. Endoscopy is used to test tissue samples in invasive methods, but it is not required in noninvasive methods. Immunohistochemistry is a highly sensitive method for diagnosing H. pylori infection in treated cases or cases with low bacterial colonization [57].

Helicobacter pylori
Bacteria, microbiome, microbiota, gut microbiota, probiotics, cancer, infection, helicobacter, stomach, infammation Infammation   H. pylori is one of the most enduring and potent human pathogens. Several strategies have been used to increase its adaptation and survival in the host body [67]. One of the most important of these strategies relates to high genetic diversity, which exhibits 2.7 to 8% polymorphisms in DNA sequences and its adaptation alongside the evolution of human hosts in various parts of the world, including the United States, Latin America, Europe, East Asia, coastal China, Hong Kong, Japan, South Asia (India), and Africa [67,68]. On the other hand, increased whole genome sequencing allows for the identifcation of new strains with greater infectivity as well as a more comprehensive understanding of the structure and function of diferent parts of the microbe [67]. As a result of the diversity of microbial strains and the breadth of genetics, several studies have addressed microbial genetics in order to better understand microbe behavior and prevent infection.
Tis systematic review concentrated on studies published in the last ten years. Te fndings revealed that H. pylori is one of the subjects that researchers have always considered, emphasizing the signifcance of H. pylori infection. However, a review of annual scientifc production revealed that the number of studies addressing H. pylori has decreased sharply since 2019 and the start of the global COVID 19 pandemic, owing to medical researchers' focus on COVID-19 disease, its related complications, ways to treat and control COVID-19 disease, and the impact of this pandemic on most medical issues, including H. pylori.
Gut, PLOS ONE, and Gastroenterology have published the most articles about H. pylori. Furthermore, China, the United States, and Japan published most H. pylori-related articles. Some of the most cited articles have been those focusing on epidemiological topics and GC. H. pylori infection, a bacterial carcinogen, is the greatest risk factor for GC, a disease that claims hundreds of thousands of lives annually [69]. Due to this, the majority of articles on GC have addressed H. pylori infection, and cancer has been mentioned more frequently than other terms (after the keywords Helicobacter, infection, and gastritis) in H. pylorirelated articles.
Te relationship between H. pylori infection and gastric malt lymphoma (GML) is well established, and the incidence of GML has decreased in recent years due to earlier diagnosis. According to the fndings of this study, the number of meta-analysis studies has increased in recent years as a result of the COVID-19 pandemic, decreased outpatient visits, travel restrictions, home quarantines, delays in elective care, and decreased patient access. Tis study also revealed that most articles focused on new treatment regimens with lower resistance and greater efcacy in eradicating H. pylori, such as the use of probiotics. Furthermore, the number of articles focusing on subjects such as B-cell lymphoma and CagA has decreased in recent years due to a better understanding of the pathophysiology of H. pylori infection, more efective treatments, and the role of species such as CagA in bacterial pathogenesis.
Te role of enzymes in establishing H. pylori infection through colonization, damage to the host epithelium, and provision of essential metabolic substrates as one of the most important virulence factors has shifted researchers' attention to the association of microbes with various enzymes in recent publications [70]. Urease, for instance, is one of the most important enzymes produced by H. pylori in order to protect the microbe from the acidic conditions of the stomach and its mucous membranes at low pH [69,71]. Catalase is an additional enzyme produced by this microorganism that contributes to its growth and survival at infammatory surfaces by catalyzing the removal of toxic oxygen species [72].
As antioxidants can prevent the production of DNAdamaging free radicals and the treatment of H. pylori infection is one of the most important topics related to this microbe, numerous studies have examined antioxidants as a means to prevent chronic infection with H. pylori and reduce the risk of GC and its treatment [15,16]. Ngan et al. reported, for instance, that Hericium erinaceus possesses antioxidant properties that can prevent H. pylori infection [73].
In H. pylori infection, the microbial community can cause changes by infuencing the population of gastric microbes [17]. By altering the microbiota of the gastric mucosa, this microorganism may infuence T-reg cell synthesis and secretion. It also attempts to maintain itself and infection by inhibiting immune responses and gastritis function [74]. Due to the complex relationship between H. pylori and other microorganisms and the increased risk of GC, several studies have attempted to identify the microbial population afected by H. pylori in the context of infectivity and tumorigenesis; however, additional research is necessary to investigate this topic [75].
Both nanoparticles and amino acids have received less research. Te issue of nanoparticles is associated with therapeutic topics. In addition, bismuth with two antibiotics metronidazole and tetracycline or metronidazole and amoxicillin is the most efective treatment to prevent H. pylori infection. On the other hand, one of the primary disadvantages of nanoparticles is their lack of shared characteristics; consequently, nanoparticles have likely been the subject of fewer studies [76,77]. Since amino acids are the only source of carbon energy for H. pylori, numerous studies have demonstrated that the majority of amino acids promote microbial activity and infectivity, while only a few, such as L-tyrosine, inhibit bacterial activity [20,78,79]. Terefore, because amino acids do not have a complex relationship with H. pylori, they are not considered interesting topics for the study by researchers.

Conclusion
Tis study identifed signifcant and infuential aspects of the Helicobacter pylori literature published between 2010 and 2021. Tese infuential characteristics will have an efect on future core investigations. In this study, researchers examined 17,413 published articles by 56,106 authors. Tis study revealed that Gut, PLOS ONE, and Gastroenterology are the most infuential journals for H. pylori research. Journals comply with Bradford's law, and 43 journals are classifed in zone 1 and are more important than others. In addition, Seoul National University has the most published Global Health, Epidemiology and Genomics papers on H. pylori. Lastly, Seoul National University and China are the infuential Helicobacter university and nation, respectively.
H. pylori infection can lead to several complications. Furthermore, the only place this organism colonizes is the stomach, as indicated by the term gastric. H. pylori requires expression of several genes or infammatory markers that establish the virulence of this bacterium. Risk factors cause symptoms or complications associated with H. pylori.
Due to its complications, H. pylori infection remains an important and challenging issue in the healthcare systems of all nations and costs a signifcant amount of money annually. It is well known that pathogenic strains such as CagA, VacA, and HtrA, activation of pathways such as NF-kappa B, and induction of tumor necrosis factor alpha protein contribute to the pathogenicity of H. pylori infection.
Future research into the targeted treatment of pathogenic strains or the treatment and control of pathogenic pathways and proteins may be of great assistance in reducing the disease's complications. In the last two years, as a result of the global COVID-19 epidemic, the number of studies on H. pylori has decreased signifcantly, and the consequences may result in an increase in complications such as GI bleeding and GC in the coming years. Tus, researchers in various felds of clinical and basic sciences should shift their attention to various facets of this signifcant bacterium.
Tis scientometric review ofers useful reference points for early-stage researchers and provides valuable in-depth information to experienced researchers and practitioners in the feld of H. pylori research. Tis scientometric analysis and visualization are promising for comprehensively refecting the global picture of classifcation-based H. pylori research and have potential for visualizing the emerging trends in other research felds [80].
Nonetheless, our research had some limitations. Our study's main limitation was a lack of access to the full text of a large number of articles. Tis cause, combined with a lack of funds, posed numerous challenges for our team in moving the project forward. An important point to consider as a future direction in upcoming projects is the relationship between H. pylori and the type of treatment described in the literature due to multiple antibiotic resistance.

Data Availability
Data are available from the corresponding author upon reasonable request.

Conflicts of Interest
Te authors declare that they have no conficts of interest.