Helicobacter pylori: friend or foe?

[esophageal adenocarcinoma]

Helicobacter pylori (H . pylori ) is a Gram -negative spiral bacterium that is present in nearly half the world 's population . It is the major cause of peptic ulcer disease and a recognized cause of gastric carcinoma . In addition , it is linked to non-ulcer dyspepsia , vitamin B 12 deficiency , iron -deficient anemia and immune thrombocytopenic purpura . These conditions are indications for testing and treatment according to current guidelines . An additional indication according to the guidelines is "anyone with a fear of gastric cancer " which results in nearly every infected person being eligible for eradication treatment . There may be beneficial effects of H . pylori in humans , including protection from gastroesophageal reflux disease and esophageal adenocarcinoma . In addition , universal treatment will be extremely expensive (more than $32 billion in the United States ), may expose the patients to adverse effects such as anaphylaxis and Clostridium difficile infection , as well as contributing to antibiotic resistance . There may also be an as yet uncertain effect on the fecal microbiome . There is a need for robust clinical data to assist in decision-making regarding treatment of H . pylori infection .