Helibacter pylori and gastroduodenal disease

Helicobacter pylori infection is now recognised to produce antral gastritis and possibly to be an aetiological factor contributing to duodenal ulceration. It has a number of virulence factors which could be relevant to the induction of inflammation and ulceration, but further work is needed to elucidate which of these factors is clinically relevant. There are a number of diagnostic tests for this organism, and the optimal combination of tests, in different clinical settings, is yet to be determined. The optimal drug regimen for the eradication of H. pylori is uncertain, but acceptable cure rates can be achieved with a combination of antibiotics and bismuth salts. New agents are being developed and assessed. Other important questions still to be answered relate to the epidemiology of this organism and its relationship, if any, to gastric cancer.