Helicobacter pylori and gastric diseases

The isolation of Helicobacter pylori from clinical specimens by Marshall and Warren 15 years ago1 launched revolutions in gastroenterology and microbiology. 2 3 Like other revolutions in history, the original directions of the H pylori story have changed in response to conflicting ideologies, observation, and practices. Currently, enthusiasts, drug companies, and the lay press are putting pressure on physicians to eliminate H pylori from all patients, symptomatic or not, in whom it is detected. There is little evidence that this is appropriate, and management will continue to change as new knowledge emerges and socioeconomic environments change in ways that are relevant to H pylori and clinical medicine. This article looks at past and current trends to anticipate the future of these common bacteria and the disorders associated with them. H pylori is one of a large family of related bacteria that are well adapted to persist in the stomachs of vertebrates for the life span of their hosts. It is likely that H pylori has colonised our stomachs since well before we became humans.4 Studies of primates and human populations in developing countries suggest that, until the last century, nearly all humans carried H pylori or closely related bacteria in their stomachs. H pylori can thus be regarded as indigenous or “normal” flora, which most humans acquire within the first few years of childhood and then carry for life. With socioeconomic development, fewer children are acquiring H pylori .5 This is a worldwide phenomenon that seems to have preceded the introduction of antibiotics, although it may have been accelerated by their widespread use. The reasons for the decline in the prevalence of H pylori colonisation are unknown. Improved nutrition and clean water have been proposed. An alternative hypothesis is that most transmission is from child to child …