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Helicobacter pylori infection

Nature Reviews Disease Primers volume 9, Article number: 19 (2023) Cite this article

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Abstract

Helicobacter pylori infection causes chronic gastritis, which can progress to severe gastroduodenal pathologies, including peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. H. pylori is usually transmitted in childhood and persists for life if untreated. The infection affects around half of the population in the world but prevalence varies according to location and sanitation standards. H. pylori has unique properties to colonize gastric epithelium in an acidic environment. The pathophysiology of H. pylori infection is dependent on complex bacterial virulence mechanisms and their interaction with the host immune system and environmental factors, resulting in distinct gastritis phenotypes that determine possible progression to different gastroduodenal pathologies. The causative role of H. pylori infection in gastric cancer development presents the opportunity for preventive screen-and-treat strategies. Invasive, endoscopy-based and non-invasive methods, including breath, stool and serological tests, are used in the diagnosis of H. pylori infection. Their use depends on the specific individual patient history and local availability. H. pylori treatment consists of a strong acid suppressant in various combinations with antibiotics and/or bismuth. The dramatic increase in resistance to key antibiotics used in H. pylori eradication demands antibiotic susceptibility testing, surveillance of resistance and antibiotic stewardship.

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Fig. 1: Key developments in H. pylori clinical research and management.
Fig. 2: Prevalence of H. pylori infection in adults and children.
Fig. 3: H. pylori infection and pathogenesis.
Fig. 4: Pathogenesis of gastric adenocarcinoma triggered by H. pylori.
Fig. 5: H. pylori diagnostic procedures.
Fig. 6: Suggested H. pylori therapy algorithm.

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Acknowledgements

The authors thank Y.-C. Chen and H.-T. Yu for help with figure design.

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Authors and Affiliations

  1. Medical Department II, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany

    Peter Malfertheiner & Christian Schulz

  2. Medical Department Klinik of Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke Universität, Magdeburg, Germany

    Peter Malfertheiner

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA

    M. Constanza Camargo

  4. Microbiome Research Centre, St George & Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia

    Emad El-Omar

  5. Department of Internal Medicine, National Taiwan University Cancer Center, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

    Jyh-Ming Liou

  6. Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA

    Richard Peek

  7. DZIF Deutsches Zentrum für Infektionsforschung, Partner Site Munich, Munich, Germany

    Christian Schulz & Sebastian Suerbaum

  8. Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria

    Stella I. Smith

  9. Max von Pettenkofer Institute, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany

    Sebastian Suerbaum

  10. National Reference Center for Helicobacter pylori, Munich, Germany

    Sebastian Suerbaum

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Contributions

Introduction (P.M.); Epidemiology (M.C.C., J.-M.L. and S.S.); Mechanisms/pathophysiology (S.S., E.E.-O. and S.S.); Diagnosis, screening and prevention (M.C.C., R.P., C.S. and S.I.S.); Management (P.M., E.E.-O. and J.-M.L.); Quality of life (M.C.C., R.P. and S.I.S.); Outlook (P.M. and J.-M.L.); Overview of the Primer (P.M.).

Corresponding author

Correspondence to Peter Malfertheiner.

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Competing interests

P.M. has consulted for Aboca, Bayer Healthcare, Cinclus, Imevax, Menarini Foundation and Phatom. P.M. has received honoraria for lectures from Allergosan, Biohit, Biocodex and Malesci. S.I.S. has received scientific support from Richen. C.S. has received speaker fees from Imevax, Falk Foundation and Lilly. S.S. is listed as an inventor on a patent application related to the use of bacterial motility inhibitors as potential treatment for Helicobacter pylori infection.

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Nature Reviews Disease Primers thanks F. Carneiro, K. McColl, Y. Yamaoka and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Malfertheiner, P., Camargo, M.C., El-Omar, E. et al. Helicobacter pylori infection. Nat Rev Dis Primers 9, 19 (2023). https://doi.org/10.1038/s41572-023-00431-8

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