Evasive strategies by the organism

H. pylori colonization persists in an apparent immunologically hostile microenvironment; however, no evidence for bactericidal activity of the local antibodies can be demonstrated. The gastric epithelium is not an immunoprivileged site. Immunoglobulin coating of bacteria, except those deep within the gastric pits, occurs in situ but these antibodies do not appear to be bactericidal. Bacterial mechanisms of immune avoidance may include a continuous loss of highly antigenic material, including the urease and flagella sheath, from the bacterial surface, thereby reducing the effectiveness of bound antibodies. Downregulation of the immune response during infection may also occur as antigen-specific responsiveness of local and circulating T cells is significantly reduced in H. pylori-positive compared with H. pylori-negative individuals, suggesting that these cells have been tolerized.

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