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The discovery of Helicobacter pylori in the 1980s has revolutionized the management of peptic ulcer disease, the most recent development being a vaccine against the bacterium. Nevertheless, strategies for the targeting and management of H. pylori are constantly developed further as several H. pylori associated clinical conditions remain an issue of debate and controversy. Research on the basic mechanisms of the infection is also continuing, and new findings and challenging views are continuously emerging, without providing definitive answers yet. This publication presents new facts useful for the clinician, addressing questions such as the contribution of bacterial virulence and genetic predisposition of the host to disease outcomes. It is also a puzzle why a smaller group of H. pylori infected patients develops clinical manifestations, but a much larger proportion remains asymptomatic. It is also discussed how to deal with the dyspeptic patient in primary care.
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