Systematic review: Effect of proton pump inhibitors on Helicobacter pylori physiology

Helicobacter pylori is a Gram-negative bacillus that colonizes the gastric mucosa and infects more than half of the world population. Treatment consists of two antibiotics and a proton pump inhibitor (PPI) that favors the replication of the bacterium and enhances the activity of the antibiotics. Despite the importance of proton pump inhibitor use in treating H. pylori infection, the precise mechanisms through which PPIs affect the physiology of the bacterium are not yet understood.

Our aim was to compile information pertaining to the effect of PPIs on the physiology of H. pylori and the mechanisms through which they produce alterations in the bacterium.

A bibliographic search was conducted, utilizing the PubMed, Science Direct, and LILACS databases, and included preclinical and clinical original articles published in any language.

The sulfenamide form of PPIs was shown to have effects on H. pylori, including the induction of structural changes, inhibition of bacterial growth, and interference with enzymes, such as urease, ATPases, and alcohol dehydrogenase.

The binding of the sulfenamide form of PPIs to the bacterial structural and enzymatic components was the main mechanism through which H. pylori physiology was altered in vitro, but how they induce alterations in the bacterium was not established in the clinical studies analyzed.