HELICOBACTER-PYLORI AND THE RISK AND MANAGEMENT OF ASSOCIATED DISEASES - GASTRITIS, ULCER DISEASE, ATROPHIC GASTRITIS AND GASTRIC-CANCER

This review addresses the role of H. pylori and the effect of H. pylor i eradication on gastritis, peptic ulcer disease, atrophic gastritis a nd gastric cancer, Specific emphasis is given to various factors that influence the clinical course of this infection, H. pylori induces chr onic gastritis in virtually all infected subjects. This inflammation c an lead to peptic ulceration and atrophic gastritis in a considerable number of infected subjects, A minority eventually develops gastric ca ncer, The risk of such complications depends upon the severity of gast ritis, which is determined by various host- and bacteria-related facto rs, Among bacterial factors, most of the evidence addresses the cagA p athogenicity island, the presence of which has been associated with mo re severe gastritis, peptic ulceration, atrophic gastritis and gastric cancer, Among host factors, most of the evidence focuses on acid prod uction in response to H. pylori infection. An increase in acid secreti on limits H. pylori gastritis to the antrum at the risk of duodenal ul cer disease; a reduction allows more proximal inflammation at the risk of atrophic gastritis, gastric ulcer disease, and gastric cancer, Gas tritis and atrophy negatively influence acid secretion, H. pylori erad ication is required in peptic ulcer disease and may be advocated in pa tients on profound acid suppressive therapy; it has been shown to cure gastritis and prevent ulcer recurrence, Further study is required to determine the efficacy of H. pylori eradication in the primary and sec ondary prevention of atrophic gastritis and gastric cancer.