Malnick Stephen David Howard, Melzer Ehud, Attali Malka, Duek Gabriel, Yahav Jacob
Stephen David Howard Malnick, Department of Internal Medicine C, Kaplan Medical Center, 76100 Rehovot, Israel.
World J Gastroenterol. 2014 Jul 21;20(27):8979-85. doi: 10.3748/wjg.v20.i27.8979.
Helicobacter pylori (H. pylori) is a Gram-negative spiral bacterium that is present in nearly half the world's population. It is the major cause of peptic ulcer disease and a recognized cause of gastric carcinoma. In addition, it is linked to non-ulcer dyspepsia, vitamin B12 deficiency, iron-deficient anemia and immune thrombocytopenic purpura. These conditions are indications for testing and treatment according to current guidelines. An additional indication according to the guidelines is "anyone with a fear of gastric cancer" which results in nearly every infected person being eligible for eradication treatment. There may be beneficial effects of H. pylori in humans, including protection from gastroesophageal reflux disease and esophageal adenocarcinoma. In addition, universal treatment will be extremely expensive (more than $32 billion in the United States), may expose the patients to adverse effects such as anaphylaxis and Clostridium difficile infection, as well as contributing to antibiotic resistance. There may also be an as yet uncertain effect on the fecal microbiome. There is a need for robust clinical data to assist in decision-making regarding treatment of H. pylori infection.
幽门螺杆菌（H. pylori）是一种革兰氏阴性螺旋菌，全球近一半人口体内都有这种细菌。它是消化性溃疡疾病的主要病因，也是公认的胃癌病因。此外，它还与非溃疡性消化不良、维生素B12缺乏症、缺铁性贫血和免疫性血小板减少性紫癜有关。根据现行指南，这些病症都是进行检测和治疗的指征。指南中的另一个指征是“任何担心患胃癌的人”，这导致几乎每个感染者都有资格接受根除治疗。幽门螺杆菌对人类可能有有益影响，包括预防胃食管反流病和食管腺癌。此外，普遍治疗将极其昂贵（在美国超过320亿美元），可能使患者面临过敏反应和艰难梭菌感染等不良反应，还会导致抗生素耐药性。对粪便微生物群可能也有尚未确定的影响。需要有力的临床数据来协助做出关于幽门螺杆菌感染治疗的决策。
