Pharmacy World and Science

, Volume 18, Issue 2, pp 49–55 | Cite as

Helicobacter pylori infection and its role in human disease — an overview

  • K. E. L. McColl


Helicobacter pylori (H. pylori) is probably the commonest chronic bacterial infection in humans. The bacterium colonizes the gastric epithelium and induces inflammation of the underlying mucosa. The recognition that this infection is the most important acquired factor in the pathogenesis of duodenal and gastric ulcers has transformed the management of these common disorders. Most patients with ulcers can be cured by a 1-week course of anti-H. pylori therapy, thereby removing the need for long-term acid inhibitory therapy. Eradication of the infection involves taking complex combinations of drugs and simpler eradication regimens are required. Recent epidemiological data indicate an association betweenH. pylori infection and the subsequent development of gastric carcinoma. If this association is established as causal, then widespread eradication of the infection may be indicated. Global eradication ofH. pylori will probably rely on prophylactic or therapeutic vaccination and this approach is being actively investigated.


Duodenal ulcer Eradication therapy Gastric cancer Helicobacter pylori 


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  1. 1.
    Graham DY, Malaty HM, Evans DG, Evans D Jr, Klein PD, Adam E. Epidemiology ofHelicobacter pylori in an asymptomatic population in the United States. Gastroenterology 1991;100:1495–1501.Google Scholar
  2. 2.
    Hook-Nikanne J, Sistonen P, Kosunen TU. Effect of ABO blood group and secretor status on the frequency ofHelicobacter pylori antibodies. Scand J Gastroenterol 1990;25:815–8.Google Scholar
  3. 3.
    Veldhuyzen van Zanten SJO, Pollak PT, Best LM, Bezanson GS, Marrie T. Increasing prevalence ofHelicobacter pylori infection with age: continuous risk of infection in adults rather than cohort effect. J Infect Dis 1994;169:434–7.Google Scholar
  4. 4.
    Kosunen TU, Hook J, Rautelin HI, Myllyla G.. Age-dependent increase ofCampylobacter pylori antibodies in blood donors. Scand J Gastroenterol 1989;24:110–4.Google Scholar
  5. 5.
    Cullen DJE, Collins BJ, Christiansen KJ, Epis J, Warren JR, Surveyor I, Cullen KJ. When isHelicobacter pylori infection acquired? Gut 1993;34:1681–2.Google Scholar
  6. 6.
    Mitchell HM, Li YY, Hu PJ, Liu Q, Chen M, Du GG, et al. Epidemiology ofHelicobacter pylori in Southern China: identification of early childhood as the critical period for acquisition. J Infect Dis 1992;166:149–53.Google Scholar
  7. 7.
    Holcombe C.Helicobacter pylori: the African enigma. Gut 1992;33:429–31.Google Scholar
  8. 8.
    Sullivan PB, Thomas JE, Wight DGD, Neale G, Eastham EJ, Corrah T, et al.Helicobacter pylori in Gambian children with chronic diarrhoea and malnutrition. Arch Dis Child 1990;65:189–91.Google Scholar
  9. 9.
    Goodwin CS, Armstrong JA. Microbiological aspects ofHelicobacter pylori (Campylobacter pylori). Eur J Clin Microbiol Infect Dis 1990;9:1:1–13.Google Scholar
  10. 10.
    Sjostedt S, Kager L, Veress B, Nord CE.Campylobacter pylori in relation to other aerobic and anaerobic microorganisms in patients with gastric diseases. Microb Ecol Health Dis 1989;2:107–14.Google Scholar
  11. 11.
    Bayerdorffer E, Lehn N, Hatz R, Mannes GA, Oertel H, Sauerbruch T, et al. Difference in expression ofHelicobacter pylori gastritis in antrum and body. Gastroenterology 1992;102:1575–82.Google Scholar
  12. 12.
    Fiocca R, Villani L, Luinetti O, Gianatti A, Perego M, Alvisi C, et al.Helicobacter colonisation and histopathological profile of chronic gastritis in patients with or without dyspepsia, mucosal erosion and peptic ulcer: a morphological approach to the study of ulcerogenesis in man. Virchows Archiv A Pathol Anat 1992;420:489–98.Google Scholar
  13. 13.
    Rauws EA, Langenberg W, Houthoff HJ, Zanen HC, Tytgat GN.Campylobacter pyloridis-associated chronic active antral gastritis. A prospective study of its prevalence and the effects of antibacterial and antiulcer treatment. Gastroenterology 1988;94:33–40.Google Scholar
  14. 14.
    Johnston BJ, Reed PI, Ali MH.Campylobacter-like organisms in duodenal and antral endoscopic biopsies: relationship to inflammation. Gut 1986;27:1132–7.Google Scholar
  15. 15.
    Satoh K, Kimura K, Yoshida Y, Kasano T, Kihira K, Taniguchi Y. Relationship betweenHelicobacter pylori colonization and acute inflammation of the duodenal mucosa. Am J Gastroenterol 1993;88:3:360–3.Google Scholar
  16. 16.
    Howden CW, Hunt RH. Relationship between gastric secretion and infection. Gut 1987;28:96–107.Google Scholar
  17. 17.
    Mobley HLT, Cortesia MJ, Rosenthal LE, Jones BD. Characterization of urease fromCampylobacter pylori. J Clin Microbiol 1988;26:5:831–6.Google Scholar
  18. 18.
    Neithercut WD, Milne A, Chittajallu RS, Nujumi AM El, McColl KEL. Detection ofHelicobacter pylori infection of the gastric mucosa by measurement of gastric aspirate ammonium and urea concentrations. Gut 1991;32:973–6.Google Scholar
  19. 19.
    Marshall BJ, Barrett LJ, Prakash C, McCallum RW, Guerrant RL. Urea protectsHelicobacter (Campylobacter) pylori from the bactericidal effect of acid. Gastroenterology 1990;99:697–702.Google Scholar
  20. 20.
    Warren JR, Marshall B. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet 1983;i:1273–5.Google Scholar
  21. 21.
    Marshall BJ, Warren R, Francis GJ, Langton SR, Goodwin CS, Blincow ED. Rapid urease test in the management ofCampylobacter pyloridis-associated gastritis. Am J Gastroenterol 1987;82;3:200–10.Google Scholar
  22. 22.
    Schnell GA, Schubert TT. Usefulness of culture, histology and urease testing in the detection ofCampylobacter pylori. Am J Gastroenterol 1989;84:2:133–99.Google Scholar
  23. 23.
    Graham DY, Klein PD, Evans DJ, Evans DG, Alpert LC, Opekun AR, Boutton TW.Campylobacter pylori detected noninvasively by the13C-Urea breath test. Lancet 1987;ii:1174–7.Google Scholar
  24. 24.
    Marshall BJ, Surveyor I. Carbon-14 urea breath test for the diagnosis ofCampylobacter pylori associated gastritis. J Nucl Med 1988;29:11–6.Google Scholar
  25. 25.
    Logan RPH, Polson RJ, Misiewicz JJ, Rao G, Karim NQ, Newell D, et al. Amplified single sample13carbon urea breath test forHelicobacter pylori: comparison with histology, culture, and ELISA serology. Gut 1991; 32:1461–4.Google Scholar
  26. 26.
    Veenendaal RA, Pena AS, Mejjer JL, Endtz HPh, van der Est MMC, van Duijn W, et al. Long term serological surveillance after treatment ofHelicobacter pylori infection. Gut 1991;32:1291–4.Google Scholar
  27. 27.
    Goossens H, Glupczynski Y, Burette A, van den Borre C, Butzler J-P. Evaluation of a commercially available second-generation immunoglobulin G enzyme immunoassay for detection ofHelicobacter pylori infection. J Clin Microbiol 1992;176–80.Google Scholar
  28. 28.
    McColl KEL, El-Nujumi AM, Chittajallu RS, Dahill SW, Dorrian CA, El-Omar E, et al. A study of the pathogenesis ofHelicobacter pylori negative chronic duodenal ulceration. Gut 1993:34:762–8.Google Scholar
  29. 29.
    Coghlan JG, Gilligan D, Humphries H, McKenna D, Dooley C, Sweeney E, et al.Campylobacter pylori and recurrence of duodenal ulcers — a 12 month follow-up study. Lancet 1987;ii:1109–11.Google Scholar
  30. 30.
    Hentschel E, Brandstatter G, Dragosics B, Hirschl AM, Nemec H, Schutze K, et al. Effect of ranitidine and amoxycillin plus metronidazole on the eradication ofHelicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med 1993;328:308–12.Google Scholar
  31. 31.
    O'Riordan T, Mathai E, Tobin E, McKenna D, Keane C, Sweeney E, et al. Adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate. Gut 1990;31:999–1002.Google Scholar
  32. 32.
    Tatsuta M, Ishikawa H, Iishi H, Okuda S, Yokota Y. Reduction of gastric ulcer recurrence after suppression ofHelicobacter pylori by cefixime. Gut 1990;31:973–6.Google Scholar
  33. 33.
    Graham DY, Lew GM, Klein PD, Evans DG, Evans DJ, Saeed ZA, et al. Effect of treatment ofHelicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. Ann Intern Med 1992;116:9:705Google Scholar
  34. 34.
    Rune SJ, Hansen JM, Jensen TG, Eriksen J, Thomsen OO, Scheibel J, et al. Prevention of duodenal ulcer recurrence with penicillin. A double-blind, placebo-controlled trial. Scand J Gastroenterol 1993;28:438–42.Google Scholar
  35. 35.
    Mantzaris GJ, Hatzis A, Tamvakologos G, Petraki K, Spiliades C, Triadaphyllou G. Prospective, randomized, investigatorblind trial ofHelicobacter pylori infection treatment in patients with refractory duodenal ulcers. Dig Dis Sci 1993;38:6:1132–6.Google Scholar
  36. 36.
    Schutze K, Hentschel E, Brandstatter G. More on the eradication ofHelicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med 1993;328:1356.Google Scholar
  37. 37.
    Hosking SW, Ling TK, Chung SCS, Yung MY, Cheng AFB, Sung JJY, et al. Duodenal ulcer healing by eradication ofHelicobacter pylori without anti-acid treatment: randomised controlled trial. Lancet 1994;343:508–10.Google Scholar
  38. 38.
    Forbes GM, Glaser ME, Cullen DJ, Warren JR, Christiansen KJ, Marshall BJ, et al. Duodenal ulcer treated withHelicobacter pylori eradication: seven-year follow up. Lancet 1994;343:258–60.Google Scholar
  39. 39.
    Marshall BJ, Goodwin CS, Warren JR, Murray R, Blincow ED, Blackbourn SJ, et al. Prospective double-blind trial of duodenal ulcer relapse after eradication ofCampylobacter pylori. Lancet 1988;ii:1437–41.Google Scholar
  40. 40.
    Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer associated with eradication ofHelicobacter pylori. Lancet 1990;335:1233–5.Google Scholar
  41. 41.
    Wilhelmsen I, Berstad A. Quality of life and relapse of duodenal ulcer before and after eradication ofHelicobacter pylori. Scand J Gastroenterol 1994;29:874–9.Google Scholar
  42. 42.
    Graham DY, Hepps KS, Ramirez FC, Lew GM, Saeed ZA. Treatment ofHelicobacter pylori reduces the rate of rebleeding in peptic ulcer disease. Scand J Gastroenterol 1993;28:939–42.Google Scholar
  43. 43.
    Labenz J. Role ofHelicobacter pylori eradication in the prevention of peptic ulcer bleeding relapse. Digestion 1994;55:19–23.Google Scholar
  44. 44.
    McColl KEL, Fullarton GM, Chittajallu R, El-Nujumi AM, Macdonald AMI, Dahill SW, et al. Plasma gastrin, daytime intragastric pH, and nocturnal acid output before and at 1 and 7 months after eradication ofHelicobacter pylori in duodenal ulcer subjects. Scand J Gastroenterol 1991;26:339–46.Google Scholar
  45. 45.
    Graham DY, Opekum A, Lew GM, Evans DJ, Klein PD, Evans DG. Ablation of exaggerated meal-stimulated gastrin release in duodenal ulcer patients after clearance ofHelicobacter (Campylobacter) pylori infection. Am J Gastroenterol 1990;85:394–8.Google Scholar
  46. 46.
    Levi S, Beardshall K, Haddad G, Playford R, Ghosh P, Calam J.Campylobacter pylori and duodenal ulcers: the gastrin link. Lancet 1989;ii:1167–8.Google Scholar
  47. 47.
    Moss SF, Legon S, Bishop AE, Polak JM, Calam J. Effect ofHelicobacter pylori on gastric somatostatin in duodenal ulcer disease. Lancet 1992;340:930–2.Google Scholar
  48. 48.
    Kaneko H, Nakada K, Mitsuma T, Uchida K, Furusawa A, Maeda Y, et al.Helicobacter pylori infection induces a decrease in immunoreactive-somatostatin concentrations of human stomach. Dig Dis Sci 1992;37:409–16.Google Scholar
  49. 49.
    Queiroz DMM, Mendes EN, Rocha GA, Moura SB, Resende LMH, Barbosa AJA, et al. Effect ofHelicobacter pylori eradication on antral gastrin-and somatostatin-immunoreactive cell density and gastrin and somatostatin concentrations. Scand J Gastroenterol 1993;28:858–64.Google Scholar
  50. 50.
    Moss SF, Calam J. Acid secretion and sensitivity to gastrin in patients with duodenal ulcer: effect of eradication ofHelicobacter pylori. Gut 1993;34:888–92.Google Scholar
  51. 51.
    El-Omar E, Penman ID, Ardill JES, Chittajallu RS, Howie C, McColl KEL.Helicobacter pylori and abnormalities of acid secretion in patients with duodenal ulcer disease. Gastroenterology 1995;109:681–91.Google Scholar
  52. 52.
    Gillen D, El-Omar E, McColl KEL. Parietal sensitivity to gastrin distinguishesH. pylori-infected DU patients from infected healthy volunteers. Gut 1995;37(Suppl 1):A8.Google Scholar
  53. 53.
    McColl KEL, El-Omar E, El-Nujumi A, Wirz A, Covacci A, Crabtree JE.Helicobacter pylori-induced disturbance of gastric acid secretion is unrelated to bacterial CagA status. Gut 1995;36(Suppl 1):A83.Google Scholar
  54. 54.
    Numura A, Stemmermann GN, Chyou P-H, Perez-Perez GI, Blaser MJ.Helicobacter pylori infection and the risk of duodenal and gastric ulceration. Ann Intern Med 1994;120:977–81.Google Scholar
  55. 55.
    Sung JY, Chung SC, Ling TKW, Yung MY, Leung VKS, Ng EKW, et al. Antibacterial treatment of gastric ulcers associated withHelicobacter pylori. N Engl J Med 1995;332:139–42.Google Scholar
  56. 56.
    Labenz J, Borsch G. Evidence for the essential role ofHelicobacter pylori in gastric ulcer disease. Gut 1994;35:19–22.Google Scholar
  57. 57.
    McCarthy C, Patchett S, Collins RM, Beattie S, Keane C, O'Morain C. Long-term prospective study ofHelicobacter pylori in nonulcer dyspepsia. Dig Dis Sci 1995;40(1):114–9.Google Scholar
  58. 58.
    Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, et al.Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 1991;325:16:1127–31.Google Scholar
  59. 59.
    Forman D, Newell DG, Fullerton F, Yarnell JWG, Stacey AR, Wald N, et al. Association between infection withHelicobacter pylori and risk of gastric cancer: Evidence from a prospective investigation. BMJ 1991;302:1302–5.Google Scholar
  60. 60.
    Hansson LE, Engstrand L, Nyren O, Evans DJ Jr, Lindgren A, Bergstrom R, et al.Helicobacter pylori infection: independent risk indicator of gastric adenocarcinoma. Gastroenterology 1993;105:1098–1103.Google Scholar
  61. 61.
    Correa P, Fox J, Fontham E, Ruiz B, Lin Y, Zavala D, et al.Helicobacter pylori and gastric carcinoma. Serum antibody prevalence in populations with contrasting cancer risks. Cancer 1990;66:2569–73.Google Scholar
  62. 63.
    Eurogast Study Group. An international association betweenHelicobacter pylori infection and gastric cancer. Lancet 1993;341:1359–73.Google Scholar
  63. 64.
    Sobala GM, Schorah CJ, Lynch DAF, Gallacher B, Dixon MF, Axon ATR. Effect of eradication ofHelicobacter pylori on gastric juice ascorbic acid concentrations. Gut 1993;34:1038–41.Google Scholar
  64. 65.
    Banerjee S, Hawksby C, Miller S, Dahill S, Beattie AD, McColl KEL. Effect ofHelicobacter pylori and its eradication on gastric juice ascorbic acid. Gut 1994;35:317–22.Google Scholar
  65. 66.
    Sobala GM, Pignatelli B, Schorah CJ, Bartsch H, Sanderson M, Dixon MF, et al. Levels of nitrite, nitrate,N-nitroso compounds, ascorbic acid and total bile acids in gastric juice of patients with and without precancerous conditions of the stomach. Carcinogenesis 1991;12:193–8.Google Scholar
  66. 67.
    Comfort MW, Kelsey MP, Berkson J. Gastric acidity before and after the development of carcinoma of the stomach. J Natl Cancer Inst 1947;7:367–73.Google Scholar
  67. 68.
    El-Omar E, Wirz A, McColl KEL. Divergent effects ofH. pylori on acid secretion. Gut 1995;37:A82.Google Scholar
  68. 69.
    Tucci A, Poli L, Paparo GF, Biasco G, Varoli O, Cioffi D, et al. Effect ofHelicobacter pylori (HP) eradication in patients with fundic atrophic gastritis. Gut 1994;35(Suppl 4):1514.Google Scholar
  69. 70.
    Yasunaga Y, Shinomura Y, Kanayama S, Yabu M, Nakanishi T, Miyazaki Y, et al. Improved fold width and increased acid secretion after eradication of the organism inHelicobacter pylori associated enlarged fold gastritis. Gut 1994;35:1571–4.Google Scholar
  70. 71.
    Bayerdorffer E, Neubauer A, Rudolph B, Theide C, Lehn N, Eidt S, et al. Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure ofHelicobacter pylori infection. Lancet 1995;345:1591–4.Google Scholar
  71. 72.
    Hussell T, Isaacson PG, Crabtree JE, Spencer J. The response of cells from low-grade B-cell gastric lymphomas of mucosa-associated lymphoid tissue toHelicobacter pylori. Lancet 1993;342:571–4.Google Scholar
  72. 73.
    NIH Consensus Conference.Helicobacter pylori in peptic ulcer disease. JAMA 1994;272:65–9.Google Scholar
  73. 74.
    Kuipers EJ, Klinkenberg-Knol EC, Havu N, Festen HPM, Lamers CBHW, Jansen JBMJ, et al.Helicobacter pylori and development of atrophic gastritis during omeprazole maintenance therapy. Gastroenterology 1995;108:A137.Google Scholar
  74. 75.
    Tytgat GNJ. Review article: treatments that impact favourably upon the eradication ofHelicobacter pylori and ulcer recurrence. Aliment Pharmacol Ther 1994;8:359–68.Google Scholar
  75. 76.
    Penston JG. Review article:Helicobacter pylori eradication — understandable caution but no excuse for inertia. Aliment Pharmacol Ther 1994;8:369–89.Google Scholar
  76. 77.
    Chiba N, Rao BV, Rademaker JW, Hunt R. Meta-analysis of the efficacy of antibiotic therapy in eradicatingHelicobacter pylori. Am J Gastroenterol 1992;87:1716–27.Google Scholar
  77. 78.
    Bell GD, Powell KU, Burridge SM, Bowden AF, Atoycbi W, Bolton GU, et al. Rapid eradication ofHelicobacter pylori Infection. Aliment Pharmacol Ther 1995;9:41–6.Google Scholar
  78. 79.
    All-Assi MT, Ramirez FC, Lew GM, Genta RM, Graham DY. Clarithromycin, tetracycline, and bismuth: a new non-metronidazole therapy forHelicobacter pylori infection. Am J Gastroenterol 1994;89:1203–5.Google Scholar
  79. 80.
    Thijs JC, van Zwet AA, Oey HB. Efficacy and side effects of a triple drug regimen for the eradication ofHelicobacter pylori. Scand J Gastroenterol 1993;28:934–8.Google Scholar
  80. 81.
    Unge P, Gad A, Gnarpe H, Olsson J. Does omeprazole improve antimicrobial therapy directed towards gastricCampylobacter pylori in patients with antral gastritis? A pilot study. Scand J Gastroenterol 1989;24:49–54.Google Scholar
  81. 82.
    Biasco G, Miglioli M, Barbara L, Corinaldesi R, Di Febo G. Otneprazole,Helicobacter pylori, gastritis and duodenal ulcer. Lancet 1989;ii:1403.Google Scholar
  82. 83.
    Bell GD, Powell KU, Burridge SM, Harrison G, Rameh B, Weil J, et al. Reinfection or recrudescence after apparently successful eradication ofHelicobacter pylori infection: implications for treatment of patients with duodenal ulcer disease. Q J Med 1993;86:375–82.Google Scholar
  83. 84.
    Czion SJ, Nedrud JG. Oral immunization againstHelicobacter pylori. Infect Immunol 1991;59:2359–63.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • K. E. L. McColl
    • 1
  1. 1.Department of Medicine and Therapeutics, Gardiner InstituteWestern InfirmaryGlasgowScotland, UK

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