Helicobacter pylori: The unsuspected and unlikely global gastroduodenal pathogen

The discovery of the bacterium Helicobacter pylori by the Australians Warren and Marshall in 1982 has revolutionized the management of gastroduodenal diseases. Antimicrobial therapy is now an essential component of the treatment of all duodenal ulcers and most gastric ulcers. A causal role in gastric adenocarcinoma and low-grade B-cell gastric lymphomas has resulted in the investigation of strategies for large scale elimination of H. pylori from certain populations. However, interest in this fascinating bacterium amongst microbiologists in general, and infectious disease researchers and clinicians throughout the world in particular, has tended to be lukewarm. Helicobacter pylori diseases are not considered a priority in the developing world and are viewed as infections for which treatment is a luxury that can be afforded only by developed societies. A thesis of this article is that mass impacts of this ubiquitous pathogen on the developing world may be more than is thought and that, in the long term, intervention may be desirable as long as it can be made simple and cheap. Progress in Helicobacter research has come such a long way in the past 10 years that immunization may now be an attainable goal.