Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.8979
Revised: January 23, 2014
Accepted: April 21, 2014
Published online: July 21, 2014
Helicobacter pylori (H. pylori) is a Gram-negative spiral bacterium that is present in nearly half the world’s population. It is the major cause of peptic ulcer disease and a recognized cause of gastric carcinoma. In addition, it is linked to non-ulcer dyspepsia, vitamin B12 deficiency, iron-deficient anemia and immune thrombocytopenic purpura. These conditions are indications for testing and treatment according to current guidelines. An additional indication according to the guidelines is “anyone with a fear of gastric cancer” which results in nearly every infected person being eligible for eradication treatment. There may be beneficial effects of H. pylori in humans, including protection from gastroesophageal reflux disease and esophageal adenocarcinoma. In addition, universal treatment will be extremely expensive (more than $32 billion in the United States), may expose the patients to adverse effects such as anaphylaxis and Clostridium difficile infection, as well as contributing to antibiotic resistance. There may also be an as yet uncertain effect on the fecal microbiome. There is a need for robust clinical data to assist in decision-making regarding treatment of H. pylori infection.
Core tip:Helicobacter pylori (H. pylori) is found in more than half the world’s population. It is a major cause of peptic ulcer disease and gastric carcinoma. The overwhelming majority of those infected will not suffer any consequences during their lifetime. Furthermore, there may be a beneficial effect of H. pylori infection on allergy and asthma in young children and a protection against gastroesophageal reflux disease and its feared complication of esophageal carcinoma. Universal eradication will be prohibitively expensive, have adverse effects and needs to be evaluated on the basis of robust clinical data that is not yet available.