Helicobacter pylori: present status and future prospects in Japan

Abstract

The discovery of Helicobacter pylori has already changed the natural history of peptic ulcer disease, with most patients being cured at their first presentation. Similarly, the incidence of gastric cancer and other diseases related to H. pylori are likely to be greatly reduced in the near future. Isolation of the spiral intragastric bacterium H. pylori totally reversed the false dogma that the stomach was sterile, and it taught us that chronic infectious disease can still exist in modern society. Helicobacter pylori's unique location, persistence, and evasion of the immune system offer important insights into the pathophysiology of the gut. Also, the fact that it was overlooked for so long encourages us to think "outside the box" when investigating other diseases with obscure etiologies. We should consider such provocative scientific ideas as bridges to the future disease control.

Fig. 1

Rokuzo Kobayashi (1887–1969), at his desk in the office of Keio University, Tokyo, Japan. Photo taken in 1935. Adopted from “Kobayashi Rokuzo” published by Dr. Rokuzo Kobayashi Memorial Association, 1971

Fig. 2

Helicobacter pylori-associated gastric oxidative injury: monochloramine pathway. MPO, myeloperoxidase; SOD, superoxide dismutase

Fig. 3

After reaching the mucosa and attaching by means of its lectins, H. pylori applies toxin to the gastric mucosa. Cells change their morphology and migrate, some detach, and sometimes apoptosis occurs. The healing process involves proliferation of adjacent, more healthy cells. Proliferation by itself is not carcinogenic, but mutagens, such as monochloramine, may be formed in the presence of ammonia and hypochlorous anion. These cause errors in transcription. Some cells differentiate into intestinal tissue, a transformation called intestinal metaplasia

Fig. 4

Worldwide consensus conferences on H. pylori eradication therapy. ESPCG, European Society for Primary Care Gastroenterology; NIH, National Institutes of Health; ADHF, American Digestive Health Foundation; OMGE, Organisation Mondiale de Gastro-Entérologie (World Gastroenterology Organization)