Who? When to treat? Gastritis, particular histological lesions, NSAID therapy and extradigestive diseases.

Indications of whom and when to treat Helicobacter pylori infection are reviewed in chronic atrophic gastritis, in particular types of gastritis (lymphocytic, giant fold, auto-immune gastritis), in hyperplastic polyps, before or during treatment with NSAIDs and in association with various extra-digestive diseases. Although there is no convincing evidence that Helicobacter pylori eradication may interrupt or reverse mucosal atrophy and intestinal metaplasia (potentially pre-cancerous lesions), indication for eradication could be considered in young patients if atrophic gastritis is considered as a consequence of chronic superficial gastritis which is reversible after Helicobacter pylori cure. The still evidence limited for a causal relationship between Helicobacter pylori and lymphocytic gastritis, giant folds gastritis and hyperplastic polyps suggests it is acceptable to eradicate Helicobacter pylori in infected patients presenting these special forms of gastritis. Despite the uncertainty on the interactions of Helicobacter pylori and NSAID in the genesis of peptic ulcer disease, it seems acceptable to prescribe eradication treatment in known Helicobacter pylori carriers before a long-term treatment with NSAID. The clinical evidence for an association between Helicobacter pylori and extra-digestive diseases is at the present time too limited to advocate routine eradication in these conditions before large prospective trials are performed.