Helicobacter infection in man: problems to be solved.

Helicobacter pylori (Hp) infection in man has several disease outcomes, varying from asymptomatic chronic gastric inflammation to Hp-associated dyspepsia, pepic ulcer disease, gastric adenocarcinoma, and Malt lymphoma. Particularly controversial is the role of Hp infection in the genesis of chronic dyspeptic symptoms. Only a small percentage of chronic dispeptics have long-lasting remission of the complaints after cure of the infection. It is now well established that healing of the inflammation through microbial eradication cures peptic ulcer disease. The high efficacy of bismuth or PPI triple and quadruple therapies is overshadowed by the rising resistance to metronidazole and clarithromycin. The exact role of Hp in gastric carcinogenesis in the various geographical areas needs further study. The results of ongoing trials, evaluating the long-term outcome of Hp cure, on cancer rates are anxiously awaited. The acquisition rate of new knowledge through basal and clinical Hp research has rarely been witnessed in medicine.