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The unsurpassed speed with which new information has been collected over the past two decades is bound to slow down. Much has been discovered and leading microbiologists are moving to other helicobacters and homing in on other parts of the body, particularly the biliary and intestinal tract. Yet knowledge of theHelicobacter pylori genome will continue to stimulate further H pylori related research; furthermore, the vaccination programme will keep the basic and clinical researchers busy for some time.
This overview will elaborate on some aspects of further developments, in full awareness of the limitations and hazards involved in speculating about the future.
Disappearance of H pyloriand H pylori associated peptic ulcer disease
In the Western developed world at least, but perhaps also on a global scale, H pylori infection is disappearing spontaneously at a surprisingly rapid rate. Several direct and indirect findings support this observation.
Many clinicians have indeed observed that H pylori associated peptic ulcer disease is becoming a rare event. In the Amsterdam unit very few new H pyloriassociated duodenal ulcers are currently seen and H pylori associated gastric ulcers have almost vanished. This same trend has been observed by El-Serag and Sonnenberg1 and by Cutler.2 The average number of patients that could be enrolled per month per research centre in the USA in various trials decreased from 0.82 in 1994 to 0.25 in 1996. Similar findings were observed in the United Kingdom by Banatvala et al,3 in Finland by Kosunen et al,4 in The Netherlands by Roosendaalet al,5 and in many other countries. The possible causes of H pyloridisappearance may well remain speculative (box FB1).
The …