The life and death of Helicobacter pylori

Gut. 1998 Jul;43 Suppl 1(Suppl 1):S56-60. doi: 10.1136/gut.43.2008.s56.


The ability of Helicobacter pylori to survive in the varying acidity of the stomach is considered to be linked to its ability to maintain a tolerable pH in its periplasmic space by acid dependent activation of internal urease activity. Whereas survival of H pylori can occur between a periplasmic pH of 4.0 to 8.0, growth can only occur between a periplasmic pH of 6.0 to 8.0. When urease activity is only able to elevate periplasmic pH to between 4.0 and 6.0, the organisms will survive but not divide. In the absence of division, antibiotics such as clarithromycin and amoxycillin are ineffective. Proton pump inhibitors, by elevating gastric pH, would increase the population of dividing organisms and hence synergise with these antibiotics.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adenosine Triphosphate / biosynthesis
  • Anti-Bacterial Agents
  • Drug Therapy, Combination / therapeutic use
  • Gastritis / microbiology
  • Helicobacter Infections / drug therapy
  • Helicobacter pylori / drug effects
  • Helicobacter pylori / metabolism
  • Helicobacter pylori / physiology*
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Hydrogen-Ion Concentration
  • Proton Pump Inhibitors
  • Ranitidine / therapeutic use
  • Stomach / microbiology
  • Urease / metabolism


  • Anti-Bacterial Agents
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Ranitidine
  • Adenosine Triphosphate
  • Urease