n this study, we used next-genera- tion sequencing to characterize the genomic changes associated with metronidazole resistance in H. pylori, where we confirmed mutations in the frxA and rdxA genes that are known to be asso- ciated with metronidazole resistance in H. pylori, and we identi- fied a putative novel mutation in the rpsU gene that likely plays a role in metronidazole resistance.