title: Role of Helicobacter pylori infection in gastric carcinogenesis: Current knowledge and future directions.
abstract: Helicobacter pylori (H. pylori) plays a role in the pathogenesis of gastric cancer. The outcome of the infection depends on environmental factors and bacterial and host characteristics. Gastric carcinogenesis is a multistep process that is reversible in the early phase of mucosal damage, but the exact point of no return has not been identified. Therefore, two main therapeutic strategies could reduce gastric cancer incidence: (1) eradication of the already present infection; and (2) immunization (prior to or during the course of the infection). The success of a gastric cancer prevention strategy depends on timing because the prevention strategy must be introduced before the point of no return in gastric carcinogenesis. Although the exact point of no return has not been identified, infection should be eradicated before severe atrophy of the gastric mucosa develops. Eradication therapy rates remain suboptimal due to increasing H. pylori resistance to antibiotics and patient noncompliance. Vaccination against H. pylori would reduce the cost of eradication therapies and lower gastric cancer incidence. A vaccine against H. pylori is still a research challenge. An effective vaccine should have an adequate route of delivery, appropriate bacterial antigens and effective and safe adjuvants. Future research should focus on the development of rescue eradication therapy protocols until an efficacious vaccine against the bacterium becomes available.
authors.affiliation: Aleksandra Sokic-Milutinovic, Tamara Alempijevic, Tomica Milosavljevic, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine University of Belgrade, 11000 Belgrade, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Sokic-Milutinovic
authors.affiliation: Aleksandra Sokic-Milutinovic, Tamara Alempijevic, Tomica Milosavljevic, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine University of Belgrade, 11000 Belgrade, Serbia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Alempijevic
authors.affiliation: Aleksandra Sokic-Milutinovic, Tamara Alempijevic, Tomica Milosavljevic, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia and School of Medicine University of Belgrade, 11000 Belgrade, Serbia.
authors.forename: Tomica
authors.initials: T
authors.lastname: Milosavljevic
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001428:Bacterial Vaccines / Q000627:therapeutic use; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D004195:Disease Models, Animal; D024881:Drug Resistance, Bacterial; D005753:Gastric Mucosa / Q000187:drug effects / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D054884:Host-Pathogen Interactions; D006801:Humans; D065840:Protective Factors; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000382:microbiology* / Q000473:pathology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines
keywords: Eradication therapy; Gastric cancer; Helicobacter pylori; Prevention; Vaccine