Review article: after gastritis--an imaginary journey into a Helicobacter-free world

This article explores the consequences of the world-wide trend that may result--at different times for different populations--in the disappearance of Helicobacter pylori and gastritis. After a brief historical introduction, some of the factors that contribute to the decrease in the prevalence of H. pylori are presented. The most apparent results of this trend in the industrialized world have been a decrease in the incidence of peptic ulcer and distal gastric adenocarcinoma. However, some other conditions of the upper digestive tract, such as acid reflux disease and adenocarcinoma of the cardio-oesophageal junction have been increasing. This simultaneous increase has led to the speculation that it may be causally related to the decreased prevalence of gastritis, and currents of thought supporting a laissez faire attitude with regards to H. pylori infection have developed. If these trends continue, future research aimed at understanding the pathogenesis of H. pylori-related conditions, including gastric carcinogenesis, will hinge on access to populations in which H. pylori is still highly prevalent, and on further refinement of the recently introduced Mongolian gerbil model.