Helicobacter pylori infection increases risk of gastric cancer, by inducing inflammation and genetic instability in the gastric mucosa. However, it is not clear how best to clear the infection, or even whether H pylori can provide some health benefits.

In a Review article in the April issue of Gastroenterology, David Y. Graham discusses the mechanisms H pylori–induced carcinogenesis and the challenges to and benefits of its eradication.

Graham describes gastric cancer approaches to screening patients with H pylori infection, and the effects of treating inflammation and neoplasias in infected patients. He discusses the different H pylori eradication therapies available and why some work when others don’t.

Graham says that the “focus on testing for superiority via comparative studies with a regimen known to be ineffective in a specific population instead of a focus on understanding the mechanisms of efficacy (such as differences in resistance), has delayed our understanding of the factors responsible for the efficacy and failure of the 4-drug combinations by more than a decade”.

Graham recommends that we collect data on the effects of resistance to each antimicrobial agent, separately and in combination, before we draw conclusions about overall efficacy.

The Review also describes ways to identify treatment failure and the proposed benefits of H pylori infection, such as in protection against esophageal disease, asthma, and obesity.