Assessing the risks and benefits of treating Helicobacter pylori infection

Abstract

Since the discovery of Helicobacter pylori by Warren and Marshall [Marshall and Warren, 1984] in 1982, much has been learned about this Gram-negative microaerophilic bacterium and its associated pathology. In 1994, the National Institutes of Health recognized that most recurrent duodenal and gastric ulcers were caused by H. pylori and antibiotic treatment was recommended. In the same year, the International Agency for Research on Cancer (IARC) declared H. pylori to be a group I human carcinogen for gastric adenocarcinoma [IARC, 1994]. Since then, physicians have been working diligently in diagnosing and treating H. pylori. Despite the fact that evidence has shown clearly H. pylori to be the culprit for gastritis, peptic ulcers and gastric malignancies including mucosa associated lymphoid tissue (MALT) lymphoma and gastric adenocarcinoma, the effect of H. pylori treatment in patients with gastroesophageal reflux disease remains controversial. In this review, we will discuss the risks and benefits of the treatment of H. pylori in different disease entities. This is summarized in Table 1. Table 1. Summary of benefits and risks of H. pylori eradication. Evidence of the clinical benefits of H. pylori eradication Gastric and duodenal ulcer The strong association between H. pylori infection and peptic ulcer disease is unarguable. Meta-analysis studies have showed superior ulcer remission rate for both gastric and duodenal ulcer in patients successfully eradicated of H. pylori infection [Singh and Ghoshal, 2006; Leodolter et al. 2001]. H. pylori eradication therapy was also more superior and cost-effective than maintenance acid suppressive therapy in preventing duodenal ulcer [Ford et al. 2004]. A study by Sharma et al. [2001] also found that H. pylori eradication was more successful in decreasing recurrent gastroduodenal ulcer bleeding compared with ulcer healing treatment alone (17% versus 4% respectively). Maintenance acid suppression therapy was also not necessary after successful H. pylori eradication and ulcer healing [Liu et al. 2003].