title: Helicobacter pylori: friend or foe?
abstract: 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.
authors.affiliation: Stephen David Howard Malnick, Department of Internal Medicine C, Kaplan Medical Center, 76100 Rehovot, Israel.
authors.forename: Stephen David Howard
authors.initials: SD
authors.lastname: Malnick
authors.affiliation: Stephen David Howard Malnick, Department of Internal Medicine C, Kaplan Medical Center, 76100 Rehovot, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Melzer
authors.affiliation: Stephen David Howard Malnick, Department of Internal Medicine C, Kaplan Medical Center, 76100 Rehovot, Israel.
authors.forename: Malka
authors.initials: M
authors.lastname: Attali
authors.affiliation: Stephen David Howard Malnick, Department of Internal Medicine C, Kaplan Medical Center, 76100 Rehovot, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Duek
authors.affiliation: Stephen David Howard Malnick, Department of Internal Medicine C, Kaplan Medical Center, 76100 Rehovot, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Yahav
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects / Q000472:pathogenicity*; D054884:Host-Pathogen Interactions; D006801:Humans; D064307:Microbiota; D010437:Peptic Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D065840:Protective Factors; D012307:Risk Factors; D013270:Stomach / Q000382:microbiology*; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Benefit; Cancer; Cost; Helicobacter pylori; Treatment
references.citation: Gastroenterology. 2005 Jul;129(1):98-104
references.pmid: 16012939
references.citation: J Infect Dis. 2000 Nov;182(5):1446-9
references.pmid: 11015236
references.citation: Lancet. 1984 Jun 16;1(8390):1311-5
references.pmid: 6145023
references.citation: Int J Cancer. 2009 Dec 1;125(11):2697-703
references.pmid: 19610064
references.citation: Curr Opin Gastroenterol. 2013 Nov;29(6):669-75
references.pmid: 24100726
references.citation: Can J Gastroenterol. 2008 May;22(5):485-9
references.pmid: 18478134
references.citation: Lancet. 1996 Jul 20;348(9021):150-4
references.pmid: 8684154
references.citation: JAMA. 2002 Apr 17;287(15):1972-81
references.pmid: 11960540
references.citation: J Clin Invest. 2009 Sep;119(9):2475-87
references.pmid: 19729845
references.citation: Ann Intern Med. 2009 Jul 21;151(2):121-8
references.pmid: 19620164
references.citation: Gastroenterology. 2010 May;138(5):1727-36; quiz e12
references.pmid: 20117111
references.citation: Gastroenterol Clin North Am. 1993 Mar;22(1):117-25
references.pmid: 8449561
references.citation: Nature. 2007 Feb 22;445(7130):915-918
references.pmid: 17287725
references.citation: Am J Gastroenterol. 2004 Sep;99(9):1833-55
references.pmid: 15330927
references.citation: Aliment Pharmacol Ther. 1995;9 Suppl 2:45-51
references.pmid: 8547528
references.citation: Gastroenterology. 2005 Nov;129(5):1753-5
references.pmid: 16285970
references.citation: Am J Med. 1996 May 20;100(5A):12S-17S; discussion 17S-18S
references.pmid: 8644777
references.citation: Aliment Pharmacol Ther. 1995;9 Suppl 2:33-9
references.pmid: 8547526
references.citation: Aliment Pharmacol Ther. 2002 Mar;16(3):559-68
references.pmid: 11876711
references.citation: Lancet. 1991 Nov 9;338(8776):1175-6
references.pmid: 1682595
references.citation: Dig Dis Sci. 2011 Feb;56(2):457-64
references.pmid: 20635147
references.citation: Annu Rev Med. 2009;60:221-31
references.pmid: 18783330
references.citation: Health Technol Assess. 2003;7(6):1-86
references.pmid: 12709294
references.citation: Gastroenterology. 1992 Mar;102(3):760-6
references.pmid: 1537513
references.citation: Arch Intern Med. 2007 Apr 23;167(8):821-7
references.pmid: 17452546
references.citation: JAMA. 2004 Jan 14;291(2):187-94
references.pmid: 14722144
references.citation: J Allergy Clin Immunol. 2007 Sep;120(3):673-9
references.pmid: 17586034
references.citation: J Natl Cancer Inst. 2005 Jan 19;97(2):142-6
references.pmid: 15657344
references.citation: Gastroenterology. 2000 Jul;119(1):7-14
references.pmid: 10889149
references.citation: Dig Dis Sci. 1999 Nov;44(11):2303-6
references.pmid: 10573378
references.citation: BMJ. 1994 Mar 19;308(6931):750-3
references.pmid: 8142828
references.citation: Health Policy. 2004 Oct;70(1):85-96
references.pmid: 15312711
references.citation: Gastrointest Endosc. 2012 Jan;75(1):39-46
references.pmid: 22018552
references.citation: Annu Rev Pathol. 2012;7:99-122
references.pmid: 21910623
references.citation: Gut. 2005 Nov;54(11):1536-40
references.pmid: 15985559
references.citation: Gut. 2005 Jun;54(6):735-8
references.pmid: 15888771
references.citation: Gut. 2001 Sep;49(3):347-53
references.pmid: 11511555
references.citation: Nat Rev Microbiol. 2013 Apr;11(4):277-84
references.pmid: 23474681
references.citation: Lancet. 2008 Aug 2;372(9636):392-7
references.pmid: 18675689
references.citation: J Clin Gastroenterol. 1999 Jun;28(4):345-7
references.pmid: 10372933
references.citation: N Engl J Med. 1999 Mar 18;340(11):825-31
references.pmid: 10080844
references.citation: N Engl J Med. 2010 Apr 29;362(17):1597-604
references.pmid: 20427808
references.citation: Am J Gastroenterol. 1998 Dec;93(12):2330-8
references.pmid: 9860388
references.citation: Eur J Intern Med. 2013 Dec;24(8):685-90
references.pmid: 23523153
references.citation: Gastroenterol Clin North Am. 2000 Sep;29(3):559-78
references.pmid: 11030073
references.citation: Int J Epidemiol. 1998 Feb;27(1):135-41
references.pmid: 9563707
references.citation: Arch Intern Med. 2000 May 8;160(9):1349-53
references.pmid: 10809040
references.citation: JAMA. 1998 Jul 22-29;280(4):363-5
references.pmid: 9686554
references.citation: JAMA. 1994 Jul 6;272(1):65-9
references.pmid: 8007082
references.citation: Lancet. 1993 May 29;341(8857):1359-62
references.pmid: 8098787
references.citation: BMJ. 1996 May 25;312(7042):1321-5
references.pmid: 8646042
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1808-25
references.pmid: 17608775
references.citation: N Engl J Med. 2002 Oct 10;347(15):1175-86
references.pmid: 12374879
references.citation: Cancer. 1998 Nov 15;83(10):2049-53
references.pmid: 9827707
references.citation: Chin J Dig Dis. 2005;6(3):114-5
references.pmid: 16045599
references.citation: Am J Gastroenterol. 2001 May;96(5):1409-16
references.pmid: 11374675
references.citation: Aliment Pharmacol Ther. 2002 Aug;16(8):1449-56
references.pmid: 12182744
references.citation: Arch Intern Med. 2011 Nov 28;171(21):1929-36
references.pmid: 22123802
references.citation: Gastroenterology. 2010 Dec;139(6):1894-1901.e2; quiz e12
references.pmid: 20727889
references.citation: J Clin Epidemiol. 2000 Feb;53(2):175-81
references.pmid: 10729690
references.citation: Aliment Pharmacol Ther. 1995;9 Suppl 2:85-91
references.pmid: 8547533
references.citation: N Engl J Med. 1991 Oct 17;325(16):1132-6
references.pmid: 1891021
references.citation: J Infect Dis. 2008 Aug 15;198(4):553-60
references.pmid: 18598192
references.citation: Am J Gastroenterol. 2005 Feb;100(2):453-9
references.pmid: 15667507
references.citation: Cancer. 2001 Aug 1;92(3):549-55
references.pmid: 11505399
references.citation: Dig Dis Sci. 2008 Jan;53(1):27-33
references.pmid: 17492381
references.citation: Arch Intern Med. 2011 Nov 28;171(21):1936-7
references.pmid: 22123803
references.citation: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD002096
references.pmid: 15674892
references.citation: Gut. 2012 May;61(5):646-64
references.pmid: 22491499