Helicobacter pylori Infection and Current Clinical Areas of Contention

Peter Malfertheiner; Michael Selgrad

Disclosures

Curr Opin Gastroenterol. 2010;26(6):618-623. 

In This Article

Abstract and Introduction

Abstract

Purpose of review The indication for Helicobacter pylori (H. pylori) eradication has been extended to few extragastroduodenal diseases. Scientific rigor needs to be applied as the list of clinical manifestations potentially related to H. pylori has disproportionally grown to its scientific evidence. Some potential beneficial aspects of H. pylori in allergic diseases and in the context of obesity are critically addressed in this review. The main challenge, however, continues to be the prevention of gastric cancer by H. pylori eradication. Strategies for identification of individuals and populations at risk are reported as well. A final aspect is dedicated to novel treatment regimens for overcoming the increasing treatment failures with proton pump inhibitor-based triple standards.
Recent findings H. pylori infection is associated with some extragastric diseases such as idiopathic thrombocytic purpura and iron deficiency anemia that benefit from eradication therapy. The inverse relation of H. pylori prevalence and the increase in allergies and obesity, as reported from epidemiological studies, has prompted research for elucidating potential underlying pathophysiological mechanisms. Strategies for gastric cancer prevention include serological screening, which allow adopting eradication therapy in individuals at high risk. New treatments for H. pylori include sequential, bismuth-based quadruple and nonbismuth-based quadruple therapies.
Summary The main clinical challenge remains prevention of H. pylori-related diseases by effective treatment and screening procedures.

Introduction

Although basic research on Helicobacter pylori (H. pylori)-related mechanisms of inflammation and carcinogenesis continues to expand, both reporting about fascinating modes of interaction between the microbe and host cells,[1,2] the general clinical interest on the H. pylori infection has declined over the past years. Nevertheless, clinical challenges are still on. Standard eradication therapies mark an increased failure rate because of the emerging resistance to antibiotics. Prevention strategies to fight gastric cancer by H. pylori eradication are still not set in place in spite of the overwhelming rationale and strong evidence for such an action.[2] A further issue of contention is whether and which extragastric disease may be causally related to H. pylori infection or whether 'adapted' microorganisms to the gastric mucosa may or may not confer some beneficial effects to the host. We address these three clinical areas in the context of the most recent scientific reports.

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