James G. Fox

Overview of Helicobacter pylori

Although diseases such as peptic ulcer disease and gastric cancer have been recognized for centuries, an infectious cause was not actively pursued until the latter part of the 20th century. Prior to 1982, peptic ulcer disease was attributed to excessive acid or stress, while gastric cancer was linked to a number of dietary factors suggested by extensive epidemiologic surveys. Both were known to be associated with chronic inflammation (gastritis) of the stomach, but this association remained unexplained. Nevertheless, the existence of gastric bacteria and a possible association with ulcer disease had been reported by investigators dating as far back as the 19th century. For example, in 1875, Bottcher and Letulle were able to demonstrate the presence of bacteria within the floor and margins of ulcers (1), and Jaworski in 1889 described the presence of spiral organisms in the sediment of gastric washings. In 1924, Luck detected the presence of urease activity within the gastric mucosa. His work on gastric urease was confirmed by Conway and Fitzgerald, who also concluded that urease was endogenously produced by gastric epithelial cells and probably functioned as a mucosal protective agent to neutralize gastric acid (2).