Antibiotic Therapy for Helicobacter pylori

Helicobacter pylori has been one of the most studied pathogens in recent times. Literature searches will yield nearly 22,000 results for studies and pa-pers published on the subject. The excitement began in 1983, the year Drs. J.R. Warren and B. Marshall published their findings concerning an ‘‘un-identified curved bacilli on gastric epithelium’ ’ [1]. Their description was quite thorough and made a case for the association of this bacterium with gastric inflammation. Salient features were pointed out, such as their near ubiquity in active chronic gastritis yet absence when there was no inflamma-tion and their distribution in relation to the mucous layer and adjacent to the gastric epithelial cells. Twenty-three years later, what is most compelling about the initial publication is the last sentence, which reads, ‘‘They may have a part to play in other poorly understood, gastritis associated diseases’’ (i.e., peptic ulcer and gastric cancer). Warren and Marshall were awarded the 2005 Nobel Prize in Medicine for their discovery of the bacterium H pylori and its role in gastritis and peptic ulcer disease. H pylori are spiral, flagellated, gram-negative rods [2]. Characteristics im-portant to their survival include motility, urease production, and the ability to bind to gastric epithelial cells. Urease is produced in great abundance by H pylori because this enzyme breaks down urea, producing ammonia, and creates a buffered pH zone around the pathogen. Recent research has also identified bacterial virulence factors that play a critical role in clinical dis-ease [3]. Virulence factors implicated in disease include the cag pathogenicit