Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2014; 20(36): 12781-12808
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12781
Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment
Traci L Testerman, James Morris
Traci L Testerman, Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
James Morris, Department of Gastroenterology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71130, United States
Author contributions: Testerman TL and Morris J solely contributed to this manuscript.
Correspondence to: Traci L Testerman, PhD, Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, United States.
Telephone: +1-318-7511267 Fax: +1-301-2953773
Received: December 17, 2013
Revised: April 17, 2014
Accepted: June 20, 2014
Published online: September 28, 2014

Helicobacter pylori (H. pylori) is an extremely common, yet underappreciated, pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host. H. pylori is the primary cause of peptic ulcers and gastric cancer. In the United States, the annual cost associated with peptic ulcer disease is estimated to be $6 billion and gastric cancer kills over 700000 people per year globally. The prevalence of H. pylori infection remains high (> 50%) in much of the world, although the infection rates are dropping in some developed nations. The drop in H. pylori prevalence could be a double-edged sword, reducing the incidence of gastric diseases while increasing the risk of allergies and esophageal diseases. The list of diseases potentially caused by H. pylori continues to grow; however, mechanistic explanations of how H. pylori could contribute to extragastric diseases lag far behind clinical studies. A number of host factors and H. pylori virulence factors act in concert to determine which individuals are at the highest risk of disease. These include bacterial cytotoxins and polymorphisms in host genes responsible for directing the immune response. This review discusses the latest advances in H. pylori pathogenesis, diagnosis, and treatment. Up-to-date information on correlations between H. pylori and extragastric diseases is also provided.

Keywords: Enterohepatic, Pathogenesis, Diagnosis, Treatment, Extragastric, CagA, Cancer, Autoimmune, Inflammation, Virulence factor

Core tip:Helicobacter pylori (H. pylori) infection remains a common cause of morbidity and mortality. Evidence for additional H. pylori-mediated diseases, as well as potentially beneficial effects of H. pylori infection, complicates decisions regarding when testing for and treating of H. pylori infections is appropriate. In the meantime, eradication of H. pylori is becoming more difficult due to increasing antibiotic resistance. This review summarizes recent findings on H. pylori pathogenesis, testing, and treatment.