Abstract

Although Helicobacter pylori has co-existed with the human race for over 50,000 years, its complexity as a bacteria is only starting to materialize. Marshall and Warren identified the bacteria in association with peptic ulcer disease in 1984,¹ and, since then, its link in the pathogenesis of ulcer disease, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma has been clearly demonstrated.^2–4 Thus, there has been a strong push to develop effective vaccination strategies with multiple recent advances in this endeavor. Yet as the negative consequences of H pylori infection have been clearly documented, emerging data suggest a protective benefit of chronic H pylori infection against chronic inflammatory diseases. Furthermore, it is important to note that only 10–15% of patients infected with H pylori will develop ulcerations, 1% will develop gastric adenocarcinoma, and less than 1% will develop mucosa-associated lymphoid tissue lymphoma.⁵ With this in mind, should we completely eliminate this long-time companion with global vaccination, and what are the risks of ridding ourselves of H pylori? In order to confidently answer these questions, further research into the positive and negative implications of asymptomatic H pylori infection needs exploration.