Helicobacter pylori: Emergence of a Superbug

INTRODUCTION It has been shown that Helicobacter pylori is highly genetically heterogeneous. A chromosome containing approximately 1,550 genes resulted in a mutant bacterial strain that adversely affects human health. Previously, regarded as a treatable infection, H. pylori is becoming harder to eradicate. The unique features in H. pylori biology such as high genetic variability, survival in the harsh conditions of the stomach, and special nitrogen metabolisms have triggered general research interest on this persistent infection. Interestingly, the notion“historic taboo” of sterility of the stomach has been changed after the successful H. pylori isolation by Marshall and Warren in 1983 (1). It is quite obvious that H. pylori is emerging as an extraordinary microorganism, which deserves careful consideration. Altogether, such particular biological features of H. pylori infection led to many queries in the minds of gastroenterologists, microbiologists, and even basic biologists, to spend thousands of hours applying for grants to study H. pylori (2). Current knowledge of the H. pylori virulence factors particularly after the latest findings in 2012 and 2013 called for new research on H. pylori and its clinical aspects (3– 5). It is a general belief that certain H. pylori virutypes should be linked to specific gastroduodenal diseases, but recent studies draw an opposite conclusion. Actually, it is rather the treatment for H. pylori that is associated with bacterial virulence. The difficulty observed in H. pylori therapy is due to unpredictable antibiotic susceptibility results in various regions, unavailability of new effective drugs, and eventually lack of patient compliance during treatment. In brief, providing a new updated definition of H. pylori infection represents a shortcoming in gastrointestinal research. In this article, we propose realistic views on H. pylori therapy and virulence according to the latest findings with focus on a new definition of diseases caused by H. pylori.