Helicobacter pylori (H. pylori)is a very common infection In India. Nevertheless there remain a lot of challenges with relation to this infection in this country. The lack of good clinical studies and absence of guidelines pertaining to the Indian sub continent makes dealing with this infection difficult. There is a lot of confusion whether to “test and treat” for H. pylori even in patients of peptic ulcer disease (PUD), un investigated dyspepsia, and those with high risk for gastric malignancy. Invasive and costly methods such as gastroscopy, rapid urease test (RUT) and biopsy are used to test H. pylori. The non-invasive and cheap diagnostic tools such as breath tests and stool tests are not easily available in India. Once the diagnosis of H. pylori infection is made, the next challenge is to determine the most effective antibiotic regimen in Indian context. Issues of antibiotic resistance and re infection make the management even more difficult. The Indian enigma of high H. pylori infection and low gastric cancer(GC) rates makes the case against eradication even more strong. It is also important to consider the genetic diversity of H. pylori in India. More long term prospective studies are required from India before we can take the eradication at community levels. Improvement of hygiene and sanitation and providing proper drinking water is a challenge that needs to be taken up by the health administration to deal with the H. pylori problem.