Helicobacter pylori Infection and Upper Gastrointestinal Disorders

It has been thirty years since the two Australians Robin Warren and Barry Marshall discovered Helicobacter pylori (H. pylori) in 1983 [1]. In order to fulfil the Koch's postulates, Marshall and Morris drank a solution which was a suspension of H. pylori. This produced gastritis from which the bacteria could be reisolated [2]. It will be interesting to see how the approach to treatment has progressed in these three decades after the discovery of the organism-based both on consensus guidelines and other research in this field. The changes in the consensus statements have been highlighted. The isolation of H. pylori from the gastric mucosa and the report of the organism's urease activity generated excitement especially when it was postulated by Marshall that these microorganisms could be the cause of gastritis and could be a dominant etiological factor in the pathogenesis of peptic ulcer disease (PUD). With the isolation of H. pylori, floodgates opened to a new era of discovery and understanding of gastroduodenal pathology. These results were a paradigm shift from the earlier belief that PUD disease was related to stress, lifestyle, and acid secretion based on the dictum of Schwarz " no acid no ulcer. " The early nineteen eighties when Warren and Marshall reported their findings coincided with omeprazole belonging to the group of proton pump inhibitors (PPIs) being introduced. This PPI was documented as a potent antisecretory agent which yielded very good results for ulcer healing and achieving a potential cure for patients with PUD when compared to the earlier drugs belonging to the group of H 2 receptor antagonists. Hence there was lot of scepticism in the gastroenterology community world over to accept that PUD was the result of infection. However, it was found that patients with PUD continued to have remission of the disease even after cessation of antisecretory therapy. The knowledge about H. pylori continued to evolve at a rapid rate, and in 1994 the first guidelines on treatment of infection with this organism were published by the US National Institute of Health (NIH) in JAMA [3]. The consensus statement was that patients with PUD and H. pylori infection require eradication of H. pylori and antisecretory drugs whether on first presentation or on recurrence of the disease, whereas in patients with nonulcer dyspepsia (NUD) with H. pylori infection the value of treating H. pylori infection remained to be determined. It was also suggested in …