The pathogenesis of Helicobacter pylori-induced gastro-duodenal diseases

Annu Rev Pathol. 2006;1:63-96. doi: 10.1146/annurev.pathol.1.110304.100125.


Helicobacter pylori is the main cause of peptic ulceration, distal gastric adenocarcinoma, and gastric lymphoma. Only 15% of those colonized develop disease, and pathogenesis depends upon strain virulence, host genetic susceptibility, and environmental cofactors. Virulence factors include the cag pathogenicity island, which induces proinflammatory, pro-proliferative epithelial cell signaling; the cytotoxin VacA, which causes epithelial damage; and an adhesin, BabA. Host genetic polymorphisms that lead to high-level pro-inflammatory cytokine release in response to infection increase cancer risk. Pathogenesis is dependent upon inflammation, a Th-1 acquired immune response and hormonal changes including hypergastrinaemia. Antral-predominant inflammation leads to increased acid production from the uninflamed corpus and predisposes to duodenal ulceration; corpus-predominant gastritis leads to hypochlorhydria and predisposes to gastric ulceration and adenocarcinoma. Falling prevalence of H. pylori in developed countries has led to a falling incidence of associated diseases. However, whether there are disadvantages of an H. pylori-free stomach, for example increased risk of esosphageal adenocarcinoma, remains unclear.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / microbiology
  • Adenocarcinoma / pathology
  • Duodenal Ulcer / microbiology
  • Duodenal Ulcer / pathology
  • Esophagitis, Peptic / microbiology
  • Esophagitis, Peptic / pathology
  • Gastrointestinal Diseases / microbiology*
  • Gastrointestinal Diseases / pathology
  • Helicobacter Infections / complications*
  • Helicobacter Infections / pathology
  • Helicobacter pylori / pathogenicity*
  • Humans
  • Lymphoma, B-Cell, Marginal Zone / microbiology
  • Lymphoma, B-Cell, Marginal Zone / pathology
  • Stomach Neoplasms / microbiology
  • Stomach Neoplasms / pathology
  • Stomach Ulcer / microbiology
  • Stomach Ulcer / pathology