Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2021; 27(7): 545-560
Published online Feb 21, 2021. doi: 10.3748/wjg.v27.i7.545
Helicobacter pylori: Commensal, symbiont or pathogen?
Vasiliy Ivanovich Reshetnyak, Alexandr Igorevich Burmistrov, Igor Veniaminovich Maev
Vasiliy Ivanovich Reshetnyak, Alexandr Igorevich Burmistrov, Igor Veniaminovich Maev, Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow 127473, Russia
Author contributions: All authors have equally contributed to the conception and design of the study, literature review and analysis, drafting critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vasiliy Ivanovich Reshetnyak, DSc, MD, PhD, Full Professor, Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, p. 1, 20 Delegatskaya Street, Moscow 127473, Russia. vasiliy.reshetnyak@yandex.ru
Received: December 5, 2020
Peer-review started: December 5, 2020
First decision: December 27, 2020
Revised: December 28, 2020
Accepted: January 21, 2021
Article in press: January 21, 2021
Published online: February 21, 2021
Abstract

This review considers the data on Helicobacter pylori (H. pylori), which have been accumulated over 40 years since its description as an etiological factor in gastrointestinal diseases. The majority of modern publications are devoted to the study of the pathogenic properties of the microorganism in the development of chronic gastritis, peptic ulcer disease, and gastric cancer, as well as methods for its eradication. However, in recent years, there have been more and more studies which have suggested that H. pylori has a beneficial, or potentially positive, effect on the human body. The authors have attempted to objectively analyze the information accumulated in the literature on H. pylori. Some studies consider it as one of the recently identified human bacterial pathogens, and special attention is paid to the evidence suggesting that it is probably part of the composition of the human microbiome as a commensal (commensal from French to English is a table companion) or even a symbiont. The presented data discussing the presence or absence of the effect of H. pylori on human health suggest that there is an apparent ambiguity of the problem. The re-assessment of the data available on H. pylori infection is important in order to answer the question of whether it is necessary to create a program of mass H. pylori eradication or to apply a more personalized approach to treating patients with H. pylori-associated gastrointestinal diseases and to perform eradication therapy.

Keywords: Helicobacter pylori, Pathogen, Commensal, Microbiome, Peptic ulcer, Gastric cancer, Asthma, Inflammatory bowel diseases

Core Tip: This review provides data on Helicobacter pylori (H. pylori) as one of the recently identified human bacterial pathogens. On the one hand, its role as a human pathogenic bacterium that is commonly found in patients with chronic gastritis, peptic ulcer disease, and gastric cancer is discussed. On the other hand, the high prevalence of H. pylori in the population and its asymptomatic coexistence with humans in most of the world’s population indicates its persistence in the body as a representative of the microbiome and as a nonpathogenic microorganism. The presented data suggest that there is an apparent ambiguity of the problem and a need for an analytically developed, comprehensive approach to study the effect of H. pylori infection on human health and to perform eradication therapy.