Helicobacter pylori as a promoter of intestinal metaplasia and gastric cancer: An alluring hypothesis in search of evidence

Objective: To examine the current evidence supporting a role for Helicobacter pylori in the genesis of intestinal metaplasia and to offer suggestions for the design of studies that could be carried out to elucidate the pathogenesis of gastric cancer. Method: Literature review. Conclusions: The epidemiologic relationship between H. pylori and gastric cancer is widely accepted; however, the sequence of events leading to the development of carcinoma is unknown. A currently accepted model is that chronic active gastritis progresses to atrophic gastritis with intestinal metaplasia, dysplasia and eventually neoplasia. The relationship between H. pylori and intestinal metaplasia remains unclear, as several studies have yielded conflicting results.