Summary
Since the discovery of Helicobacter pylori our views concerning the pathogenesis and treatment of gastroduodenal disease have changed dramatically. Most individuals infected with this organism remain asymptomatic throughout life. However, some manifest clinical disease, such as gastric and duodenal ulcer. Recently results have also implicated H. pylori infection in the development of gastric lymphoma of mucosa-associated lymphoid tissue and gastric cancer. Variations of an individual’s immune response based on inheritance, age or environmental factors could explain the diverse clinical outcomes of the infection. However, our understanding concerning these mechanisms is still very incomplete.
Marked neutrophilic infiltration within the gastric mucosa induced by bacterial components may account for acute mucosal damage. Chronic infection is accompanied by T cell and B cell infiltration into lymphoid follicles, which could contribute to atrophy and malignant transformation of glandular epithelium.
Antimicrobial therapy can eradicate the organism, thus alleviating the host’s immune response. More efficient treatment regimens such as the combination of the proton pump inhibitor omeprazole with amoxicillin are now being used. These combinations have fewer adverse effects and improve patient compliance.
Oral vaccines may be useful for the prophylactic treatment of large populations in whom the incidence of H. pylori infection is especially high. The scarcity of studies on vaccine development may be attributed to 3 factors: (a) lack of knowledge of suitable immunogens for immunisation; (b) lack of appropriate animal models; (c) the poorly characterised cellular immune response towards specific antigens of the organism. Further research into the immunopathogenesis of H. pylori-related disease is necessary.
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Hatz, R., Bayerdörffer, E., Lehn, N. et al. Immune Response in Helicobacter pylori Infection. Clin. Immunother. 2, 295–306 (1994). https://doi.org/10.1007/BF03258529
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DOI: https://doi.org/10.1007/BF03258529