Volume 1, Issue 4 (July 2022)

Authors' Guidelines
Make a Submission
Other Format
Helicobacter Pylori, Infection, Virulence Factors and Treatment: A Review
Amer A. Haamadi
 College of Applied Medical Sciences, University of Kerbala, Karbala - Iraq
Mohsen Hashim Risan
 College of Biotechnology, University of Al- Nahrain, Baghdad - Iraq
 Corresponding Author
Hassan M. Abo Almaali
 College of Pharmacy, University of Kerbala, Karbala - Iraq
ISSN(e): 2790-296X
ISSN(p): 2957-5826
About the Journal
Editor in Chief:
Prof. Dr. Emad Al-Mulla
BCS is published quarterly
Editorial Office:
Commercial Plot 33 Millennium Plaza, G-15 Markaz, Margalla 02, Islamabad, Pakistan

Gastric and ulcer peptic disease is a common disease in the community. Considering the close relationship between peptic ulcer and gastritis caused by Helicobacter pylori. The prevalence of H. pylori increased markedly with age with the maximum colonization  (81.5%)  occurring  in adults  (40-60 years). H. pylori are bacteria that can cause an infection in the stomach or duodenum (first part of the small intestine). It’s the most common cause of peptic ulcer disease. H. pylori can also inflame and irritate the stomach lining (gastritis). Untreated, long-term H. pylori infection can lead to stomach cancer (rarely). H. pylori multiply in the mucus layer of the stomach lining and duodenum. The bacteria secrete an enzyme called urease that converts urea to ammonia. This ammonia protects the bacteria from stomach acid. As H. pylori multiply, it eats into stomach tissue, which leads to gastritis and/or gastric ulcer. Symptoms include dull or burning stomach pain, unplanned weight loss and bloody vomit. H-pylori-caused ulcers are commonly treated with combinations of antibiotics. Usually two antibiotics are prescribed. Among the common choices are amoxicillin, clarithromycin (Biaxin®), metronidazole (Flagyl®) and tetracycline and Proton pump inhibitor: Commonly used proton pump inhibitors include lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole (Protonix®), rabeprazole (Aciphex®) or esomeprazole (Nexium®). and  Bismuth subsalicylate: Sometimes this drug (eg, Pepto-Bismol®) is added to the antibiotics plus proton pump inhibitor combinations mentioned above. This drug protects the stomach lining. combination treatment is usually taken for 14 days. One newer medication, Talicia®, combines two antibiotics (rifabutin and amoxicillin) with a proton pump inhibitor (omeprazole) into a single capsule.

  1. Abo Almaali, H. M. M. (2014). Investigation of vacA genotypes of Helicobacter pylori from samples in Karbala Governorate (Doctoral dissertation, Ph. D. theses, genetic engineering and biotechnology, Baghdad University, Iraq).
  2. Al-Baldawi, M. R. (1997). Isolation and identification of Helicobacter pylori from patients with duodenal ulcer and studying its pathogenicity and antibiotic sensitivity, M.Sc. thesis, College of Science, Baghdad University, Iraq.
  3. Aljeboury, G. H., Risan, M. H., & Algafari, R. N. (2020). Role of VAC a and CAG a Genes in Detection and Identification of Helicobacter Pylori. Indian Journal of Public Health, 11(02), 2287.
  4. Alm, R. A., Bina, J., Andrews, B. M., Doig, P., Hancock, R. E., & Trust, T. J. (2000). Comparative genomics of Helicobacter pylori: analysis of the outer membrane protein families. Infection and immunity, 68(7), 4155-4168.
  5. Alm, R. A., Ling, L. S. L., Moir, D. T., King, B. L., Brown, E. D., Doig, P. C., ... & Trust, T. J. (1999). Genomic-sequence comparison of two unrelated isolates of the human gastric pathogen Helicobacter pylori. Nature, 397(6715), 176-180.
  6. Amundsen, S. K., Fero, J., Hansen, L. M., Cromie, G. A., Solnick, J. V., Smith, G. R., & Salama, N. R. (2008). Helicobacter pylori AddAB helicase‐nuclease and RecA promote recombination‐related DNA repair and survival during stomach colonization. Molecular microbiology, 69(4), 994-1007.
  7. Anstee, D. J. (2010). The relationship between blood groups and disease. Blood, The Journal of the American Society of Hematology, 115(23), 4635-4643.
  8. Aspholm, M., Olfat, F. O., Nordén, J., Sondén, B., Lundberg, C., Sjöström, R., ... & Borén, T. (2006). SabA is the H. pylori hemagglutinin and is polymorphic in binding to sialylated glycans. PLoS pathogens, 2(10), e110.
  9. Aspholm, M., Olfat, F. O., Nordén, J., Sondén, B., Lundberg, C., Sjöström, R., ... & Borén, T. (2006). SabA is the H. pylori hemagglutinin and is polymorphic in binding to sialylated glycans. PLoS pathogens, 2(10), e110.
  10. Azevedo, M., Eriksson, S., Mendes, N., Serpa, J., Figueiredo, C., Resende, L. P., ... & David, L. (2008). Infection by Helicobacter pylori expressing the BabA adhesin is influenced by the secretor phenotype. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland, 215(3), 308-316.
  11. Bäckström, A., Lundberg, C., Kersulyte, D., Berg, D. E., Borén, T., & Arnqvist, A. (2004). Metastability of Helicobacter pylori bab adhesin genes and dynamics in Lewis b antigen binding. Proceedings of the National Academy of Sciences, 101(48), 16923-16928.
  12. Bazzoli, F. (2001). Key points from the revised Maastricht Consensus Report: the impact on general practice. European Journal of Gastroenterology & Hepatology, 13, S3-7.
  13. Beek, D. V. D., & Craen, A. D. (1999). A systematic review of Helicobacter pylori eradication therapy—the impact of antimicrobial resistance on eradication rates. Alimentary Pharmacology & Therapeutics, 13(8), 1047-1055.
  14. Boren, T., Falk, P., Roth, K. A., Larson, G., & Normark, S. (1993). Attachment of Helicobacter pylori to human gastric epithelium mediated by blood group antigens. Science, 262(5141), 1892-1895.
  15. Cellini, L., Vecchio, A. D., Candia, M. D., Campli, E. D., Favaro, M., & Donelli, G. (2004). Detection of free and plankton‐associated Helicobacter pylori in seawater. Journal of Applied Microbiology, 97(2), 285-292.
  16. Coelho, L. G. V., León-Barúa, R., & Quigley, E. M. (2000). Latin-American consensus conference on Helicobacter pylori infection. The American Journal of Gastroenterology, 95(10), 2688.
  17. Colbeck, J. C., Hansen, L. M., Fong, J. M., & Solnick, J. V. (2006). Genotypic profile of the outer membrane proteins BabA and BabB in clinical isolates of Helicobacter pylori. Infection and immunity, 74(7), 4375-4378.
  18. Dore, M. P., Leandro, G., Realdi, G., Sepulveda, A. R., & Graham, D. Y. (2000). Effect of pretreatment antibiotic resistance to metronidazole and clarithromycin on outcome of Helicobacter pylori therapy. Digestive diseases and sciences, 45(1), 68-76.
  19. Dubois, A., & Borén, T. (2007). Helicobacter pylori is invasive and it may be a facultative intracellular organism. Cellular microbiology, 9(5), 1108-1116.
  20. Falk, P., Roth, K. A., Boren, T., Westblom, T. U., Gordon, J. I., & Normark, S. (1993). An in vitro adherence assay reveals that Helicobacter pylori exhibits cell lineage-specific tropism in the human gastric epithelium. Proceedings of the National Academy of Sciences, 90(5), 2035-2039.
  21. Fujimoto, S., Ojo, O. O., Arnqvist, A., Wu, J. Y., Odenbreit, S., Haas, R., ... & Yamaoka, Y. (2007). Helicobacter pylori BabA expression, gastric mucosal injury, and clinical outcome. Clinical Gastroenterology and Hepatology, 5(1), 49-58.
  22. Gerhard, M., Lehn, N., Neumayer, N., Borén, T., Rad, R., Schepp, W., ... & Prinz, C. (1999). Clinical relevance of the Helicobacter pylori gene for blood-group antigen-binding adhesin. Proceedings of the National Academy of Sciences, 96(22), 12778-12783.
  23. Goodwin, A. C., Weinberger, D. M., Ford, C. B., Nelson, J. C., Snider, J. D., Hall, J. D., ... & Forsyth, M. H. (2008). Expression of the Helicobacter pylori adhesin SabA is controlled via phase variation and the ArsRS signal transduction system. Microbiology, 154(8), 2231-2240.
  24. Goodwin, C. S., Armstrong, J. A., Chilvers, T., Peters, M., Collins, M. D., Sly, L., ... & Harper, W. E. (1989). Transfer of Campylobacter pylori and Campylobacter mustelae to Helicobacter gen. nov. as Helicobacter pylori comb. nov. and Helicobacter mustelae comb. nov., respectively. International Journal of Systematic and Evolutionary Microbiology, 39(4), 397-405.
  25. Haamadi, A. A., Risan, M. H., AboAlmaali, H. M., Sayah, H. A., & Abbas, A. H. (2021a). Used of Probiotic Production of Saccharomyces boulardii to Eradication Triple Therapy of Helicobacter pylori Infection. Scientific Journal of Medical Research, 5(18); 40-45.
  26. Haamadi, A. A., Risan, M. H., AboAlmaali, H. M., Sayah, H. A., & Abbas, A. H. (2021b). Detection H. pylori Infection by BabA Gene From Clinical Isolate in Karbala City, Iraq. Scientific Journal of Medical Research, 5(17); 29-35.
  27. Hennig, E. E., Allen, J. M., & Cover, T. L. (2006). Multiple chromosomal loci for the babA gene in Helicobacter pylori. Infection and immunity, 74(5), 3046-3051.
  28. Henriksson S.; Fei Y. Y.; Schmidt A.; Bylund G.; Johansson D. X. and Lebrilla C. et al. (2012). Helicobacter pylori – Multitalented adaptation of binding properties. Analytical Chemistry Journal. 83(16): 6336–6341.
  29. Hessey, S. J., Spencer, J., Wyatt, J. I., Sobala, G., Rathbone, B. J., Axon, A. T., & Dixon, M. F. (1990). Bacterial adhesion and disease activity in Helicobacter associated chronic gastritis. Gut, 31(2), 134-138.
  30. Hidaka, E., Ota, H., Hidaka, H., Hayama, M., Matsuzawa, K., Akamatsu, T., ... & Katsuyama, T. (2001). Helicobacter pylori and two ultrastructurally distinct layers of gastric mucous cell mucins in the surface mucous gel layer. Gut, 49(4), 474-480.
  31. Hojo, M., Miwa, H., Nagahara, A., & Sato, N. (2001). Pooled analysis on the efficacy of the second-line treatment regimens for Helicobacter pylori infection. Scandinavian Journal of Gastroenterology, 36(7), 690-700.
  32. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, International Agency for Research on Cancer, & World Health Organization. (1994). Schistosomes, liver flukes and Helicobacter pylori (Vol. 61). International Agency for Research on Cancer.
  33. Ilver, D., Arnqvist, A., Ogren, J., Frick, I. M., Kersulyte, D., Incecik, E. T., ... & Borén, T. (1998). Helicobacter pylori adhesin binding fucosylated histo-blood group antigens revealed by retagging. Science, 279(5349), 373-377.
  34. Ishijima, N., Suzuki, M., Ashida, H., Ichikawa, Y., Kanegae, Y., Saito, I., ... & Mimuro, H. (2011). BabA-mediated adherence is a potentiator of the Helicobacter pylori type IV secretion system activity. Journal of Biological Chemistry, 286(28), 25256-25264.
  35. Jain, P., Luo, Z. Q., & Blanke, S. R. (2011). Helicobacter pylori vacuolating cytotoxin A (VacA) engages the mitochondrial fission machinery to induce host cell death. Proceedings of the National Academy of Sciences, 108(38), 16032-16037.
  36. Jiménez-Soto, L. F., Kutter, S., Sewald, X., Ertl, C., Weiss, E., Kapp, U., ... & Haas, R. (2009). Helicobacter pylori type IV secretion apparatus exploits β1 integrin in a novel RGD-independent manner. PLoS pathogens, 5(12), e1000684.
  37. Kawai, M., Furuta, Y., Yahara, K., Tsuru, T., Oshima, K., Handa, N., ... & Kobayashi, I. (2011). Evolution in an oncogenic bacterial species with extreme genome plasticity: Helicobacter pyloriEast Asian genomes. BMC microbiology, 11(1), 1-28.
  38. Kawakubo, M., Ito, Y., Okimura, Y., Kobayashi, M., Sakura, K., Kasama, S., ... & Nakayama, J. (2004). Natural antibiotic function of a human gastric mucin against Helicobacter pylori infection. Science, 305(5686), 1003-1006.
  39. Kivi, M., Johansson, A. L. V., Reilly, M., & Tindberg, Y. (2005). Helicobacter pylori status in family members as risk factors for infection in children. Epidemiology & Infection, 133(4), 645-652.
  40. Kwok, T., Zabler, D., Urman, S., Rohde, M., Hartig, R., Wessler, S., ... & Backert, S. (2007). Helicobacter exploits integrin for type IV secretion and kinase activation. Nature, 449(7164), 862-866.
  41. Laine, L., Chun, D., Stein, C., El-Beblawi, I., Sharma, V., & Chandrasoma, P. (1996). The influence of size or number of biopsies on rapid urease test results: a prospective evaluation. Gastrointestinal endoscopy, 43(1), 49-53.
  42. Lam, S. K., & Talley, N. J. (1998). Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. Journal of Gastroenterology and Hepatology, 13(1), 1-12.
  43. Lee, M., Kemp, J. A., Canning, A., Egan, C., Tataronis, G., & Farraye, F. A. (1999). A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy. Archives of internal medicine, 159(19), 2312-2316.
  44. Lind, T., van Zanten, S. V., Unge, P., Spiller, R., Bayerdörffer, E., O'Morain, C., ... & Idström, J. P. (1996). Eradication of Helicobacter pylori using one‐week triple therapies combining omeprazole with two antimicrobials: the MACH I Study. Helicobacter, 1(3), 138-144.
  45. Lindén, S., Mahdavi, J., Semino-Mora, C., Olsen, C., Carlstedt, I., Borén, T., & Dubois, A. (2008). Role of ABO secretor status in mucosal innate immunity and H. pylori infection. PLoS pathogens, 4(1), e2.
  46. Linz, B., Balloux, F., Moodley, Y., Manica, A., Liu, H., Roumagnac, P., ... & Achtman, M. (2007). An African origin for the intimate association between humans and Helicobacter pylori. Nature, 445(7130), 915-918.
  47. Lu, H., Yamaoka, Y., & Graham, D. Y. (2005). Helicobacter pylori virulence factors: facts and fantasies. Current opinion in gastroenterology, 21(6), 653-659.
  48. Mahdavi, J., Sondén, B., Hurtig, M., Olfat, F. O., Forsberg, L., Roche, N., ... & Borén, T. (2002). Helicobacter pylori SabA adhesin in persistent infection and chronic inflammation. Science, 297(5581), 573-578.
  49. Marshall, B., & Warren, J. R. (1984). Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. The lancet, 323(8390), 1311-1315.
  50. Mégraud, F., & Lehours, P. (2007). Helicobacter pylori detection and antimicrobial susceptibility testing. Clinical microbiology reviews, 20(2), 280-322.
  51. Meyer, J. M., Silliman, N. P., Wang, W., Siepman, N. Y., Sugg, J. E., Morris, D., ... & Hopkins, R. J. (2002). Risk factors for Helicobacter pylori resistance in the United States: the surveillance of H. pylori antimicrobial resistance partnership (SHARP) study, 1993–1999. Annals of internal medicine, 136(1), 13-24.
  52. Misiewicz, J. J., Harris, A. W., Bardhan, K. D., Levi, S., O’morain, C., Cooper, B. T., ... & Lansoprazole Helicobacter Study Group. (1997). One week triple therapy for Helicobacter pylori: a multicentre comparative study. Gut, 41(6), 735-739.
  53. Necchi, V., Candusso, M. E., Tava, F., Luinetti, O., Ventura, U., Fiocca, R., ... & Solcia, E. (2007). Intracellular, intercellular, and stromal invasion of gastric mucosa, preneoplastic lesions, and cancer by Helicobacter pylori. Gastroenterology, 132(3), 1009-1023.
  54. Odenbreit, S., Swoboda, K., Barwig, I., Ruhl, S., Borén, T., Koletzko, S., & Haas, R. (2009). Outer membrane protein expression profile in Helicobacter pylori clinical isolates. Infection and immunity, 77(9), 3782-3790.
  55. Ohnishi, N., Yuasa, H., Tanaka, S., Sawa, H., Miura, M., Matsui, A., ... & Hatakeyama, M. (2008). Transgenic expression of Helicobacter pylori CagA induces gastrointestinal and hematopoietic neoplasms in mouse. Proceedings of the National Academy of Sciences, 105(3), 1003-1008.
  56. Ohno, T., Vallström, A., Rugge, M., Ota, H., Graham, D. Y., Arnqvist, A., & Yamaoka, Y. (2011). Effects of blood group antigen–binding adhesin expression during Helicobacter pylori infection of mongolian gerbils. Journal of Infectious Diseases, 203(5), 726-735.
  57. Palframan, S. L., Kwok, T., & Gabriel, K. (2012). Vacuolating cytotoxin A (VacA), a key toxin for Helicobacter pylori pathogenesis. Frontiers in Cellular and Infection Microbiology, 2, 92.
  58. Parsonnet, J., Shmuely, H., & Haggerty, T. (1999). Fecal and oral shedding of Helicobacter pylori from healthy infected adults. Jama, 282(23), 2240-2245.
  59. Perri, F., Festa, V., Clemente, R., Villani, M. R., Quitadamo, M., Caruso, N., ... & Andriulli, A. (2001a). Randomized study of two “rescue” therapies for Helicobacter pylori-infected patients after failure of standard triple therapies. The American Journal of Gastroenterology, 96(1), 58-62.
  60. Perri, F., Villani, M. R., Quitadamo, M., Annese, V., Niro, G. A., & Andriulli, A. (2001). Ranitidine bismuth citrate‐based triple therapies after failure of the standard ‘Maastricht triple therapy’: a promising alternative to the quadruple therapy?. Alimentary pharmacology & therapeutics, 15(7), 1017-1022.
  61. Peterson, W. L., Ciociola, A. A., Sykes, D. L., McSorley, D. J., & Webb, D. D. (1996). Ranitidine bismuth citrate plus clarithromycin is effective for healing duodenal ulcers, eradicating H. pylori and reducing ulcer recurrence. RBC H. pylori Study Group [see comments]. Alimentary pharmacology & therapeutics, 10(3), 251-261.
  62. Pride, D. T., & Blaser, M. J. (2002). Concerted evolution between duplicated genetic elements in Helicobacter pylori. Journal of molecular biology, 316(3), 629-642.
  63. Rohde, M., Püls, J., Buhrdorf, R., Fischer, W., & Haas, R. (2003). A novel sheathed surface organelle of the Helicobacter pylori cag type IV secretion system. Molecular microbiology, 49(1), 219-234.
  64. Rossum, L. V. (1999). Evaluation of treatment regimens to cure Helicobacter pylori infection—a meta‐analysis. Alimentary pharmacology & therapeutics, 13(7), 857-864.
  65. Schreiber, S., Konradt, M., Groll, C., Scheid, P., Hanauer, G., Werling, H. O., ... & Suerbaum, S. (2004). The spatial orientation of Helicobacter pylori in the gastric mucus. Proceedings of the National Academy of Sciences, 101(14), 5024-5029.
  66. Skoog, E. C., Sjöling, Å., Navabi, N., Holgersson, J., Lundin, S. B., & Lindén, S. K. (2012). Human gastric mucins differently regulate Helicobacter pylori proliferation, gene expression and interactions with host cells. PloS one, 7(5), e36378.
  67. Styer, C. M., Hansen, L. M., Cooke, C. L., Gundersen, A. M., Choi, S. S., Berg, D. E., ... & Solnick, J. V. (2010). Expression of the BabA adhesin during experimental infection with Helicobacter pylori. Infection and Immunity, 78(4), 1593-1600.
  68. Suerbaum, S., & Michetti, P. (2002). Helicobacter pylori infection. New England Journal of Medicine, 347(15), 1175-1186.
  69. Sugimoto, M., Ohno, T., Graham, D. Y., & Yamaoka, Y. (2011). Helicobacter pylori outer membrane proteins on gastric mucosal interleukin 6 and 11 expression in Mongolian gerbils. Journal of gastroenterology and hepatology, 26(11), 1677-1684.
  70. Talarico, S., Whitefield, S. E., Fero, J., Haas, R., & Salama, N. R. (2012). Regulation of Helicobacter pylori adherence by gene conversion. Molecular microbiology, 84(6), 1050-1061.
  71. Tegtmeyer, N., Wessler, S., & Backert, S. (2011). Role of the cag‐pathogenicity island encoded type IV secretion system in Helicobacter pylori pathogenesis. The FEBS journal, 278(8), 1190-1202.
  72. Toller, I. M., Neelsen, K. J., Steger, M., Hartung, M. L., Hottiger, M. O., Stucki, M., ... & Müller, A. (2011). Carcinogenic bacterial pathogen Helicobacter pylori triggers DNA double-strand breaks and a DNA damage response in its host cells. Proceedings of the National Academy of Sciences, 108(36), 14944-14949.
  73. Wessler, S., & Backert, S. (2008). Molecular mechanisms of epithelial-barrier disruption by Helicobacter pylori. Trends in microbiology, 16(8), 397-405.
  74. Weyermann, M., Adler, G., Brenner, H., & Rothenbacher, D. (2006). The mother as source of Helicobacter pylori infection. Epidemiology, 332-334.
  75. Yamaoka, Y. (2008). Roles of Helicobacter pylori BabA in gastroduodenal pathogenesis. World journal of gastroenterology: WJG, 14(27), 4265.
  76. Zanten, S. V. V. (1999). The DU‐MACH study: eradication of Helicobacter pylori and ulcer healing in patients with acute duodenal ulcer using omeprazole based triple therapy. Alimentary Pharmacology & Therapeutics, 13(3), 289-295.

No citation yet. Please check again later.
How to Cite:
Haamadi, A. . A., Risan, M. H. ., & Almaali, H. M. A. (2022). Helicobacter Pylori, Infection, Virulence Factors and Treatment: A Review. Biomedicine and Chemical Sciences1(4), 278–288.
Publisher’s Note:
International Research and Publishing Academy (iRAPA) stands neutral with regard to jurisdictional claims in the published maps and institutional affiliations.
© 2022 Biomedicine and Chemical Sciences published by International Research and Publishing Academy (iRAPA) - Pakistan Co-published by Al-Furat Al-Awsat Technical University - Iraq
This is an Open Access article published under the Creative Commons Attribution 4.0 International (CC BY 4.0) (
Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honour or reputation.