Costa JMC, Aguiar CEO, Oliveira MMGL, Cenci Dietrich V, Lima PHM, Freire JPC, Lemos FFB, Queiroz DMM, de Melo FF. Update on the pathogenesis and clinical management of Helicobacter pylori gastric infection and associated diseases. World J Gastrointest Pathophysiol 2025; 16(4): 111432 [PMID: 41479869 DOI: 10.4291/wjgp.v16.i4.111432]
Corresponding Author of This Article
Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
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Gastroenterology & Hepatology
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Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 22, 2025 (publication date) through Feb 26, 2026
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World Journal of Gastrointestinal Pathophysiology
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2150-5330
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Costa JMC, Aguiar CEO, Oliveira MMGL, Cenci Dietrich V, Lima PHM, Freire JPC, Lemos FFB, Queiroz DMM, de Melo FF. Update on the pathogenesis and clinical management of Helicobacter pylori gastric infection and associated diseases. World J Gastrointest Pathophysiol 2025; 16(4): 111432 [PMID: 41479869 DOI: 10.4291/wjgp.v16.i4.111432]
World J Gastrointest Pathophysiol. Dec 22, 2025; 16(4): 111432 Published online Dec 22, 2025. doi: 10.4291/wjgp.v16.i4.111432
Update on the pathogenesis and clinical management of Helicobacter pylori gastric infection and associated diseases
Juan Marcos Caram Costa, Carlos Eduardo Oliveira Aguiar, Marina Maria Gomes Leite Oliveira, Victoria Cenci Dietrich, Pedro Henrique Melo Lima, João Pedro Camargo Freire, Fabian Fellipe Bueno Lemos, Dulciene Maria de Magalhães Queiroz, Fabrício Freire de Melo
Juan Marcos Caram Costa, Carlos Eduardo Oliveira Aguiar, Marina Maria Gomes Leite Oliveira, Victoria Cenci Dietrich, Pedro Henrique Melo Lima, João Pedro Camargo Freire, Fabian Fellipe Bueno Lemos, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Dulciene Maria de Magalhães Queiroz, Laboratory of Research in Bacteriology, UFMG, Belo Horizonte 30130-100, Minas Gerais, Brazil
Co-corresponding authors: Dulciene Maria de Magalhães Queiroz and Fabrício Freire de Melo.
Author contributions: Costa JMC, Queiroz DMM, and de Melo FF conceptualized and designed the manuscript. Costa JMC, Aguiar CEO, Oliveira MMGL, Dietrich VC, Lima PHM, Freire JPC, and Lemos FFB contributed to the investigation and prepared the first draft of the manuscript. Costa JMC, Dietrich VC, and Lima PHM developed the tables and figures. Costa JMC, de Melo FF, and Queiroz DMM performed the critical editing and revision of the manuscript. Queiroz DMM and de Melo FF supervised the preparation of the manuscript and the entire writing process. Both authors have made essential and complementary contributions that justify their designation as co-corresponding authors. Specifically, de Melo FF supervised the development of the review structure, guided the integration of molecular and clinical aspects of Helicobacter pylori infection, reviewed all figures and tables for accuracy, coordinated the final revision of the text and also oversaw the correspondence and submission process. Queiroz DMM, contributed with her extensive expertise in H. pylori pathogenesis and laboratory research, providing conceptual and scientific guidance throughout manuscript preparation. Queiroz DMM reviewed and refined the sections on virulence mechanisms, immunological responses, and disease associations, ensuring scientific accuracy and depth. Queiroz DMM supervised the interpretation of recent literature and critically revised the manuscript for intellectual content, coherence, and clarity. The collaboration between de Melo FF and Queiroz DMM was fundamental for the scientific quality and completion of this work. Both have equally shared responsibilities for the correspondence, supervision of the project, and approval of the final version of the manuscript.
Supported by the CNPq Research Productivity Fellow, No. 317005/2021-9.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Corresponding author: Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Hormindo Barros, 58, Quadra 17, Lote 58, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
Received: June 30, 2025 Revised: July 26, 2025 Accepted: October 27, 2025 Published online: December 22, 2025 Processing time: 176 Days and 8.6 Hours
Abstract
Helicobacter pylori (H. pylori) is a gram-negative, spiral-shaped, microaerophilic bacterium that infects over 43% of the global population, with higher prevalence in regions of low socioeconomic status and poor sanitation. It is transmitted mainly through oral-oral and fecal-oral routes and has evolved multiple mechanisms that allow colonization of the acidic gastric environment, including urease production, chemotaxis, and a variety of adhesins. The bacterium expresses several virulence factors that enhance its pathogenicity, such as cytotoxin-associated antigen A, vacuolating cytotoxin A, and the small regulatory RNA NikS, found to be essential for the fine-tuning of the bacterial virulence. Although many infected individuals remain asymptomatic, H. pylori infection is associated with multiple clinical outcomes, including chronic gastritis, peptic ulcers, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma, all correlated to the host immune response and chronic inflammation. Diagnosis relies on both invasive and non-invasive methods, and growing antibiotic resistance poses a major challenge to treatment. New therapeutic strategies, such as tailored therapy, potassium-competitive acid blockers, and probiotics are under investigation. Vaccine development remains a key area of research, with several candidates currently in preclinical and clinical evaluation.
Core Tip: Helicobacter pylori (H. pylori) is a gastric pathogen that infects more than 40% of the world’s population. Pathophysiological mechanisms of infection and evolution to severe diseases range from host’s immunological responses and virulence factors, which are intricately regulated. Diagnosis and treatment strategies have been evolving in order to overcome the burden of antibiotic resistance and the need for invasive procedures. This article aims to provide an overview of H. pylori infection, highlighting important advances in the understanding of pathogenesis and new insights for effective clinical management.
