Progress in our understanding of H. pylori infection and gastritis

It is now clear that Helicobacter pylori colonizes the entire gastric mucosa from the cardia to the pylorus — and thus, should perhaps be called Helicobacter ventriculi. The infection induces gastritis anywhere within the stomach. What is still uncertain, however, is the prediction of possible serious sequelae of an H. pylori infection. Which patients with H.pylori-induced gastritis are at risk of developing ulcer disease or a malignant gastric tumour? It has long been known that nutritional factors, salt high diet, smoked foods, few vitamins etc. increase the risk of contracting a carcinoma of the stomach1. It is, however, also known that gastric carcinoma arises almost exclusively in H. pylori-induced gastritis, and extremely rarely develops in a healthy gastric mucosa. An important task to be resolved, therefore, is the search for organism- and host-related factors that favour the development of gastric carcinoma, that is, the identification of a ‘risk gastritis’. Of particular importance would be the detection of risk markers capable of predicting the danger of a gastric carcinoma developing. Healing such a ‘risk gastritis’ might then help to prevent cancer of the stomach. Research efforts aimed at establishing the pathogenicity factors of the organism have so far failed to achieve a breakthrough; the identification of an organism as the sole definitive carcinogen has not yet been successful2.