Helicobacter pylori: Past, present and future

Much has been achieved in Helicobacter pylori research, to the point that t he growth of new knowledge is bound to slow down. However, expectations for further developments remain high. Knowledge about the characteristic organ ism and behaviour is already extensive. Particularly intriguing are the dif ferences in genetic make-up in the various geographical regions. Sadly, det ailed knowledge on how the organism spreads is still lacking. The spectrum of clinical presentation in humans is largely known. Helicobacter pylori is disappearing worldwide, allowing the relative frequency of H. pylori-negat ive ulcer disease to increase. The extent to which H. pylori disappearance and eradication is responsible for decreasing prevalence of gastric cancer remains speculative. Antimicrobial therapy is dominated by proton pump inhi bitor triple therapy as first line therapy, with quadruple therapy as secon d rescue line therapy. The long-term consequences of the rising resistance to the 'key' antimicrobials are so far unknown, because few data are availa ble on therapeutic outcomes in routine practice outside pharmaceutical tria ls. (C) 2000 Blackwell Science Asia Pty Ltd.