Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2016; 22(11): 3150-3157
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3150
Vaccine against Helicobacter pylori: Inevitable approach
Amin Talebi Bezmin Abadi
Amin Talebi Bezmin Abadi, Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-111, Iran
Author contributions: Talebi Bezmin Abadi A collected the data and wrote the paper.
Conflict-of-interest statement: Author declares no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Amin Talebi Bezmin Abadi, PhD, Assistant Professor, Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-111, Iran.
Telephone: +98-21-82884883 Fax: +98-21-82884883
Received: December 14, 2015
Peer-review started: December 16, 2015
First decision: December 30, 2015
Revised: January 5, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: March 21, 2016

Over three decades have passed since the discovery of Helicobacter pylori (H. pylori), and yet many questions about its treatment remain unanswered. For example, there is no certainty regarding continued use of current antibiotic therapy against H. pylori. The bad news is that even combined regimens are also unable to eradicate bacterial colonization. The worst problem with H. pylori chemotherapy is that even if we identify the most successful regimen, it cannot eliminate the risk of re-infection. This problem is further complicated by the fact that clinicians have no information as to whether probiotics are useful or not. Moreover, to date, we have no large scale produced vaccine effective against H. pylori. Due to the relatively rapid and abundant dissemination of guidelines globally reported concerning management of gastric cancer prevention and therapeutic regimens, clinicians may choose a vaccine as better effective weapon against H. pylori. Therefore, a radical shift in adopted strategies is needed to guide ultimate decisions regarding H. pylori management. In light of failures in vaccine projects, we should identify better vaccine design targeting conserved/essential genes. The unique character and persistence of H. pylori pose obstacles to making an effective vaccine. Preferably, in developing countries, the best reasonable and logical approach is to recommend prophylactic H. pylori vaccine among children as an obligatory national program to limit primary colonization. Trying to produce a therapeutic vaccine would be postponed until later. In reality, we should not forget to prescribe narrow spectrum antibiotics. In the current review, I draw a route to define the best adopted strategy against this rogue bacterium.

Keywords: Helicobacter pylori, Vaccine, Eradication, Probiotic

Core tip: This review article for first time discusses actual approaches regarding management of Helicobacter pylori (H. pylori) infection; whether we should continue current strategies or focus on various directions. Primary H. pylori colonization usually happens in childhood and lasts for decades if not treated. An ultimate strategy regarding the infection must be the complete eradication of the bacterium. Herein, we provide specific recommendations on elimination of H. pylori with vaccination as well as addressing the preventive vaccine against the bacterium rather than continuing defeated solutions including probiotics or antibiotic therapy.