HELICOBACTER GASTRODUODENITIS:
A Serious Infectious Disease.
Antibiotic treatment may prevent
deaths in the decades ahead.
Infection with Helicobacter pylori (HP) is the main cause of human gastritis, the major
cause of peptic ulcer, and an important risk factor for gastric cancer. Antibiotic therapy
is recommended for patients with peptic ulcer disease. (HP is a necessary but not a
sufficient cause of peptic ulcer —at least for those not caused by NSAIDs. That is,
the great majority of persons infected do not developed peptic ulcer disease.Other factors
must be present. RTJ)
A more difficult dilemma, however, concerns the management of the growing number of
dyspeptic patients who are diagnosed with confirmed H pylori infection but no ulcer. No
convincing evidence exists to suggest that eradicating H pylori improves the symptoms of
non-ulcer dyspepsia, but as testing for the infection becomes more common, the question
arises whether prophylactic treatment should be given.
"Ethical and legal difficulties may confront the doctor who diagnoses a patient as H
pylori positive and fails to treat. Even if serious sequelae are uncommon, is it
appropriate to tell these patients that they have an infection which conveys no known
benefit to them, that increases their risk of peptic ulcer and cancer, and that may be
transmitted to their children, but does not require treatment?"
"It is timely to consider H pylori gastroduodenitis as a disease in its own right,
with ulcer and cancer as its important complications. Until reliable means can be found to
identify the 1 who become seriously ill, all those with the disease must be considered
to be at risk of a potentially fatal outcome."
BMJ May 17, 1997 314: 1430-31 Editorial, first author from General Infirmary at Leeds, UK
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