Humans and H. pylori: the relationship isn’t one dimensional

The beneficial effects of H. pylori in human health have possibly been underestimated, throwing shade on widespread eradication programs, according to Australian clinicians.

While still largely seen as the infectious cause of gastritis, peptic ulcers and gastric cancer, an editorial in JGH Open [link here] said H. pylori had co-evolved with humans as a commensal organism in the gastric microbiome.

The editorial, co-authored by Professor Ian Roberts-Thomson from the University of Adelaide, said the 2015 Kyoto consensus report on H. pylori gastritis recommended eradication treatment whether or not it was associated with symptoms.

“This recommendation promotes the belief that “the only good H. pylori is a dead H. pylori” and includes the assumption that the infection is associated with few, if any, beneficial effects,” the editorial said.

“With the passage of time, this recommendation may need to be re-examined in the light of new epidemiological data that suggests a relationship between H. pylori infection and lower risks for obesity and important gastrointestinal diseases such as IBD, GERD, and oesophageal cancer.”

Professor Roberts-Thomson and colleagues said rising rates of obesity in developed countries, where the H. pylori prevalence is falling, support the possibility of a link between H. pylori and weight control.

As well, several studies have shown a lower-than-expected frequency of H. pylori in patients with allergic disorders such as asthma and immunologic disorders such as IBD.

They said meta-analyses had found H. pylori colonisation reduced the risk of IBD by 38%–52%. [links here and here]

“For clinical gastroenterologists, the final potential benefit of H. pylori lies in the links between gastric infection with H. pylori, GERD, Barrett’s oesophagus, and the risk of oesophageal adenocarcinoma,” they said.

Rates of oesophageal adenocarcinoma in the US had increased more than three-fold in the last 50 years, they said, “making it the fastest rising malignancy in that country.”

“As eradication of infection increases acid secretion in a substantial majority, the overall effect is an increase in the acid secretion that increases the risk of GERD. By extension, more prominent oesophageal inflammation could increase the risk of Barrett’s oesophagus and the subsequent risk of adenocarcinoma.”

They said policies that favour eradication regimens in infected individuals may well be appropriate in Eastern and Central Asia countries which have a high burden of gastric cancer.

“However, similar policies in countries with a lower burden of gastric cancer may need to be re-examined in the light of newer epidemiologic information. One day, perhaps, studies will examine the use of H. pylori for the treatment of human disease.”

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