Future candidates for indications of Helicobacter pylori eradication: Do the indications need to be revised?

Abstract

Since the discovery of Helicobacter pylori in 1982, the development of several treatment guidelines has allowed a consensus on the indications for H. pylori eradication. Beyond these currently accepted indications, including various upper gastrointestinal disorders and extragastric diseases, a significant amount of new information regarding H. pylori eradication is emerging. Certain types of acute gastritis, such as nodular gastritis, hypertrophic gastritis, Ménétrier's disease, hemorrhagic gastritis, and granulomatous gastritis are reversible after H. pylori eradication. Further, for chronic gastritis, closed-type atrophic gastritis and complete-type intestinal metaplasia appear to be more reversible after H. pylori eradication than open-type atrophic gastritis and incomplete-type intestinal metaplasia. Eradication can also be considered in subjects younger than 40 years who have a family history of gastric cancer and in subjects with long-term medications that might lead to bleeding (antiplatelet agents) or atrophy (proton pump inhibitors). Emerging evidence indicates that H. pylori eradication could be an effective treatment for some extragastric diseases that are unresponsive to conventional therapy. In such conditions, routine screening for eradication of H. pylori has not previously been recommended; a "test-and-treat" approach is suggested in the aforementioned situations. Given that H. pylori eradication is effective when the gastritis is reversible, future indications should be expanded to include acute gastric lesions that show marked improvement upon H. pylori eradication rather than just focusing on chronic gastric lesions. Future indications for H. pylori eradication should focus more on reversible lesions before preneoplastic conditions develop.

Validation of western Helicobacter pylori IgG antibody assays in Korean adults

“…However, it has been shown that Koreans and their Western counterparts differ in regard to the types of H. pylori they harbour, with Koreans showing a high prevalence of the East Asian CagA type (Lee, 2012(Lee, , 2014Seo et al, 2011). Therefore, serological assays should be validated in each population and a consensus report also stated that only validated commercial tests should be used (Malfertheiner et al, 2012).…”

IL-17A G197A and C1249T polymorphisms in gastric carcinogenesis

“…pylori infection and subsequent gastritis promote gastric carcinogenesis, but the exact association between H. pylori infection and the development of gastric cancer remains elusive, in that findings across independent studies are controversial and inconclusive [25][26][27]. Interestingly, while cancer risk is increasing, H. pylori infection also plays a protective role by attenuating the progression of gastric cancer [28,29].…”

Current evidence of effects ofHelicobacter pylorieradication on prevention of gastric cancer

“…Consistent indications among these guidelines with high levels of evidence are peptic ulcer diseases and gastric mucosa-associated lymphoid tissue lymphoma (low-grade). Each guideline recommends H. pylori treatment in specific conditions as a preventive tool for GC according to the available evidence [15]. The most consistent recommendation is after endoscopic resection of GC.…”