Helicobacter pylori: “A benign fellow traveler or an unwanted inhabitant”

The recent decades have witnessed an alarming increase in the Helicobacter pylori associated diseases worldwide. In spite of this, deficiencies in our knowledge still exist about its exact epidemiology, the optimum method of its diagnosis and indeed about the precise role it plays in gastric carcinogenesis. In the present article, we review the available literature in an attempt to assign a definite role to this unique gastric pathogen. The acquisition of the cag-PAI has undoubtedly altered the understanding of host-microbe interactions, and growing appreciation of other potential determinants viz: vacA, iceA, babA, hrgA etc., may enable us understand the role of this organism and its gradual transition from a commensal to a pathogen.