Treatment of Helicobacter pylori: where are we now? What are the key questions?

Over the 14 years since Helicobacter pylori came to the attention of the medical community, we have reached the position that the organism is generally believed to be a serious pathogen. It causes a chronic infection with complications that include gastric and duodenal ulcer, gastric mucosa-associated lymphoid tissue lymphoma and gastric cancer. It is therefore an important cause of morbidity and mortality. We still do not have a perfect treatment for the infection, but enormous strides have been made since its discovery and acceptable treatments are now available. The best of these are the acid pump inhibitor- and ranitidine bismuth citrate-based triple therapies that provide 85-95% eradication in most studies. Better treatments and vaccination programmes may become available now that the Helicobacter genome has been decoded, raising the possibility of 'designer' antibiotics and vaccines. In the meantime, the current key questions are: How can our current therapies be improved? Who should be treated? What, if any, are the potential risks of widespread H. pylori eradication? And how is the organism transmitted? Without doubt, many of these questions will be addressed in the succeeding years. The papers presented in these proceedings represent an up-to-date analysis (much of it based on new data) by recognized experts. The views expressed are often provocative, but are backed by scientific data.