Contemplating the future without Helicobacter pylori and the dire consequences hypothesis

Abstract

Helicobacter pylori is a serious chronic transmissible pathogen that causes gastric structural and functional damage and is a major cause of morbidity and mortality worldwide. H. pylori is one of the digestive tract pathogens that has traveled with mankind since before humans moved out of Africa. Some have suggested that the long association of H. pylori with humans means there must be a benefit and suggest dire consequences will follow its eradication. Fortunately, there are now sufficient experiences with the outcome of treatment and with populations where the infection disappeared long ago to support the conclusion that H. pylori is a serious chronic transmissible pathogen that no one needs, deserves, or desires. The dire consequence hypotheses have proven to be erroneous attempts to blame some of the problems facing the modern world on a pathogen that was and is responsible for much suffering, morbidity, and mortality. It is time to join together to eradicate it and to let H. pylori join smallpox and polio on the hit list of undesirables.

Figure 1

Age-related incidence (per 100,000 per year) of different cancers among men in the United States is compared with the mortality related to gastric ulcer among men in the UK in 1947 [46]. The cancer data show that adenocarcinoma of the esophagus, despite its marked increase, is a very rare disease with an incidence approximately equal to small bowel cancer. Even after the marked decline in gastric cancer in the US, it remains a much more important problem than adenocarcinoma of the esophagus. Data from the SEER database for the period of 1997–2001 [47]. Clearly the trade-off of loss of gastric cancer and peptic ulcer for higher acid secretion favors eradication. Considering the low prevalence of H. pylori in the high-risk group of White men, all of the effects of H. pylori eradication have likely already occurred. However, effects from diet and obesity will continue to be felt.

Figure 2

Prevalence of Helicobacter pylori infection in low-prevalence populations (healthy and blood donor Malays [37,39] and Javanese [40]) in whom H. pylori infection is hypothesized to have been reintroduced following the immigration of Indians and Chinese into the region.