Fig. 1

Stopping the Helicobacter pylori induced disease cascade. Depending on the host and bacterial characteristics the initial colonization will result in gastritis and this will either result in clinical symptoms (symptomatic patient) where screening for the presence of Helicobacter and its resistance needs to be performed in order to allow for rational treatment. If the infection does not result in clinical symptoms (asymptomatic patient) it may still be advisable to use a single non-invasive fecal antigen screen at age 40 or so (when usually symptoms have not yet developed) to test for the presence of Helicobacter. When this test is positive fecal DNA test detecting Helicobacter specific virulence factors to predict infection with a virulent strain, and/or a noninvasive serologic follow-up screen to establish the degree of atrophy is advisable. If either of these tests predict there is a high risk for the development of gastric cancer eradication is advisable. Elimination of strains that contain virulence markers associated with an increased risk for disease development (regardless of what pathogenicity - if any it is causing in its current host) will l reduce the spread of virulent strains and thereby force the population of circulating Helicobacter isolates into less pathogenic Helicobacters, irrespective of the contribution of host genetics and environmental factors