RSS Feeds
In a World of Black and White, Helicobacter pylori Is Gray
- Martin J. Blaser, MD
- Vanderbilt University School of Medicine; Veterans Affairs Medical Center; Nashville, TN 37232 (Blaser)
Vision without action is a daydream.
Action without vision is a nightmare.
-Derived from The Analects of Confucius
All over the world, physicians are treating patients who carry Helicobacter pylori in an attempt to eradicate the organism. The discovery of H. pylori(1) and its relationship with peptic ulcer disease and gastric cancer (2) has led to a new era. In a relatively short time, the field of gastric microbiology has moved from obscurity to a central stage in medical practice. In this editorial I review the fundamental associations between H. pylori and human health and disease. The issues of how best to diagnose the presence of the organism and how best to eliminate it must follow from the larger question: In whom is elimination of H. pylori beneficial?
Consensus Issues
In the past 15 years, much has been learned about H. pylori(2). We know that once H. pylori is acquired, colonization continues for life unless the organism is eliminated by antimicrobial treatment or by the usually late-in-life development of atrophic gastritis. We also know that essentially everyone who carries the organism in the gastric mucous layer has evidence of tissue reaction (termed chronic active gastritis), yet most colonized persons remain asymptomatic for life. In the absence of treatment, the presence of H. pylori can be determined with a high degree of confidence by endoscopy (with culture, histologic examination, or urease testing of gastric biopsy specimens), by serologic testing, or by urea breath tests. After successful treatment, specific antibody levels decrease so slowly that serologic testing cannot be used to document success for at least 6 months. We know that colonization with H. pylori is associated with an increased risk for developing peptic ulcer disease, noncardia gastric adenocarcinomas, and gastric mucosa-associated lymphoid type (MALT) B-cell lymphomas (2, 3). We …
This 100-word excerpt has been provided in the absence of an abstract.
