Helicobacter pylori, diagnosis and treatment after 10 years of its discovery

The most significant epidemiological findings over this review period have been the isolation of Helicobacter pylori from the faeces and the results of the Eurogast Study firmly linking colonisation by Helicobacter pylori to the development of gastric carcinoma. With respect to the mechanism(s) of pathogenesis, the purification of the cytotoxin and an investigation of its mode of action are also important. Similarly the demonstration of the effects of Helicobacter pylori on somatostatin and gastrin-releasing peptide levels open further avenues of research. Numerous serological tests are currently available and an increasing use in screening procedures to reduce endoscopy workloads can be anticipated. The current regimen giving the highest eradication rate is bismuth+metroindazole+tetracycline for two weeks although the use of omeprazole with antibiotics is becoming more often used. Finally, the development of a vaccine is likely to be a major research area for the future.