Since the rediscovery of Helicobacter pylori in the early 1980s, evidence has begun to mount to support an etiologic role for this bacterium in the development of gastroduodenal disease and gastric cancer. During the past year, we have witnessed remarkable breakthroughs with regard to immunotherapy to prevent and perhaps cure chronic Helicobacter infection. These exciting discoveries have also been accompanied by an improved understanding of the pathogenesis of H. pylori and its relationship to peptic ulcer disease and gastric cancer. This review highlights many of the recent important developments published during the past year. It also examines new important information regarding the epidemiology, transmission, and diagnosis of H. pylori infection and summarizes the advances made in understanding the role H. pylori plays in the development of gastritis, peptic ulcer disease, and gastric cancer. The cumulative work demonstrates steady progress toward a more complete understanding of this interesting gastric pathogen.