Objective To investigate the risk factors associated with helicobacter pylori (HP) eradication failure among active-duty military personnel and to construct a risk prediction model for HP eradication failure. Methods A prospective cohort study was conducted on 240 active-duty military personnel who were diagnosed with HP-related peptic ulcer and received standard bismuth-containing quadruple therapy at the Endoscopy Center of Hunan Provincial Corps Hospital of Chinese People’s Armed Police Force from June 2021 to June 2025, and the eradication effect was assessed at least 4 weeks after completion of therapy using the ¹³C/¹⁴C urea breath test. Demographic, clinical, lifestyle, and psychological behavior data were collected using structured questionnaires. Firth logistic regression analysis was used for univariate and multivariate analysis to screen independent risk factors for HP eradication failure and to construct a risk prediction model. Model discrimination was evaluated using the area under the receiver operating characteristic curve, and risk stratification was performed according to the tertiles of the risk scores. Results Of the 240 patients, 210 achieved HP eradication and 30 failed, with an overall eradication rate of 87.5%. Univariate Firth logistic regression analysis showed that age, body mass index, ulcer size, previous HP treatment history, medication adherence, alcohol consumption, training intensity, psychological stress, regularity of meals, and high-salt diet were significantly associated with the risk of HP eradication failure (P<0.05). Multivariate Firth logistic regression analysis identified previous HP treatment history (OR=4.99,95%CI:1.04-24.58,P=0.045), poor medication adherence (OR=6.69,95%CI:1.72~27.52,P=0.006),increased training intensity (OR=4.25, 95%CI:2.26~9.19,P<0.001),and elevated psychological stress scores (OR=7.65,95%CI:3.66~20.19,P<0.001) as independent risk factors for HP eradication failure. The risk prediction model based on the above factors achieved an AUC of 0.964, indicating its strong discriminative ability. After stratification based on tertiles of the risk scores, no eradication failure was observed in the low-risk group, while the failure rates were 4.4% in the medium-risk group and 36.4% in the high-risk group. Conclusions Previous HP treatment history, poor medication adherence, increased training intensity, and elevated psychological stress scores are independent risk factors for HP eradication failure among active-duty military personnel. The risk prediction model based on these factors demonstrates good discriminative ability and potential for risk stratification, which can provide reference for the early identification and individualized intervention of high-risk individuals.