Helicobacter pylori infection: a dynamic process from diagnosis to treatment

Abstract

Helicobacter pylori, a gram-negative microaerophilic pathogen, causes several upper gastrointestinal diseases, such as chronic gastritis, peptic ulcer disease, and gastric cancer. For the diseases listed above, H. pylori has different pathogenic mechanisms, including colonization and virulence factor expression. It is essential to make accurate diagnoses and provide patients with effective treatment to achieve positive clinical outcomes. Detection of H. pylori can be accomplished invasively and noninvasively, with both having advantages and limitations. To enhance therapeutic outcomes, novel therapeutic regimens, as well as adjunctive therapies with probiotics and traditional Chinese medicine, have been attempted along with traditional empiric treatments, such as triple and bismuth quadruple therapies. An H. pylori infection, however, is difficult to eradicate during treatment owing to bacterial resistance, and there is no commonly available preventive vaccine. The purpose of this review is to provide an overview of our understanding of H. pylori infections and to highlight current treatment and diagnostic options.

Keywords: Helicobacter pylori; antibiotic resistance; diagnostic strategy; pathogenesis; treatment.

Figure 1

Helicobacter pylori-related diseases. This paper discusses two categories of H. pylori-related disorders: gastrointestinal (gastritis, peptic ulcer disease, and gastric cancer) and extragastric diseases. Extragastric disorders are further classified into four types: dermatologic, hematologic, neurologic, and hepatobiliary system manifestations.

Figure 2

Pathogenesis of Helicobacter pylori infection. The pathogenic mechanism of H. pylori is based on its ability to colonize, which includes the action of urease, flagella, and adhesins. Virulence factors, such as CagA and VacA, play a distinct role.

Figure 3

Treatment of Helicobacter pylori infections. Traditional experiential therapies for H. pylori include triple, bismuth quadruple, concomitant, and dual therapies. Probiotics, nanotechnology, and traditional Chinese medicine are all essential adjuvant therapies.

Figure 4

Resistance mechanisms of Helicobacter pylori. The development of resistance in H. pylori is primarily driven by mechanisms that involve the inactivation of enzymes, alteration of the target site for antimicrobial activity, reduction of outer membrane permeability, and enhancement of the active efflux system.