Review article: Helicobacter pylori - where are we and where are we going?

This paper contains a personal view on what has been achieved in Helicobact er pylori research and what the expectations might be for further developme nts, knowledge about the organism is already extensive. Particularly intrig uing are the differences in genetic make-up in the various geographical reg ions. Sadly, detailed knowledge on how the organism spreads is still lackin g. The clinical spectrum of the disease in man is largely known, but as H. pylori is disappearing worldwide, the relative frequency of H. pylori-negat ive ulcer disease is increasing. To what extent H. pylori disappearance and eradication is responsible for the decreasing incidence of gastric cancer remains uncertain. Antimicrobial therapy is dominated by proton pump inhibi tor triple therapy as first line with quadruple therapy as second-line ther apy. The long-term consequences of the rising resistance to the 'key' antim icrobials are so far unknown and speculative.