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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
.