Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3150
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.
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.