Helicobacter pylori Infection: When Should It Be Treated?

  • I. W. Fong
Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC)


The discovery of Helicobacter pylori [formerly Campylobacter pylori] in 1982 had revolutionized the treatment and concept of the pathogenesis of peptic ulcer disease and gastric cancer. Phylogeographic and genetic studies have indicated that the bacteria have been present in humans for >50,000 years and the distribution reflect ancient migration patterns. H. pylori strains are distributed globally and the prevalence and incidence are greater in developing countries and lower socioeconomic strata of society. Humans are the main reservoir and transmission is by the fecal–oral route. The prevalence of H. pylori colonization in the global population has been estimated to be in 4.4 billion people or greater than half of the world’s population. The bacteria is considered the cause [or strongly associated] with duodenal ulcer [90%], gastric ulcer [50–80%], gastric cancer [60–90%], and mucosa-associated lymphoid tissue [MALT] lymphoma in most cases. However, most people with H. pylori colonization are asymptomatic and are colonized for many decades or indefinitely. The treatment of H. pylori infection has only been well established for peptic ulcer disease and early MALT, but many general practitioners and some gastroenterologists are treating patients with dyspepsia, gastroesophageal reflux symptoms, and asymptomatic infections with the same regimens designed for peptic ulcer disease. Widespread use of these antibiotic regimens maybe fueling increased antimicrobial resistance of H. pylori and enteric bacteria. This chapter reviews and discusses current concepts of H. pylori-associated diseases including pathogenesis, epidemiology, diagnosis, indications for treatment, therapeutic regimens, prevention of gastric cancer, and vaccine development.


Peptic ulcer disease Dyspepsia Chronic gastritis Gastric cancer Screening Asymptomatic MALT Treatment regimens 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • I. W. Fong
    • 1
  1. 1.St. Michael’s HospitalUniversity of TorontoTorontoCanada

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