HELICOBACTER-PYLORI, DUODENAL-ULCER, GASTRIC-CANCER - TUNNEL VISION OR BLINDERS

The focus of this paper is on the relationship between Helicobacter py lori gastritis and gastric cancer, one of the most compelling issues a fter the recent decision of the IARC (International Agency for Researc h on Cancer) to categorize H, pylori as a carcinogen. Our aim is to id entify areas where additional work is not needed and suggest new direc tions of inquiry, We review what has been accomplished with the advant age of hindsight, Our review of the data regarding current putative vi rulence factors found that disease and outcome specificity were lackin g, The same can be said of the data regarding low gastric juice ascorb ate or increased mucosal cell turnover in H, pylori gastritis. We conc lude that, while it is certainly possible that some of the factors dis covered to date may initiate or mediate certain pathogenetic aspects o f H. pylori-related disease, none of them can be seriously proposed as the factor responsible for either gastric cancer or duodenal ulcer, F inally, we identified research areas that might lead to disease-specif ic associations as well as areas where helicobacters may be used as mo dels for other diseases, We propose that it is time to pause, reflect on what has been done, and focus more sharply on the questions that re main unanswered.