Helicobacter pylori (H. pylori) may enter a non-replicative, non-culturable, low metabolically active state, the so-called coccoid form, to survive in extreme environmental conditions. Since coccoid forms are not susceptible to antibiotics, they could represent a cause of therapy failure even in the absence of antibiotic resistance, i.e., relapse within one year. Furthermore, coccoid forms may colonize and infect the gastric mucosa in animal models and induce specific antibodies in animals and humans. Their detection is hard, since they are not culturable. Techniques, such as electron microscopy, polymerase chain reaction, loop-mediated isothermal amplification, flow cytometry and metagenomics, are promising even if current evidence is limited. Among the options for the treatment, some strategies have been suggested, such as a very high proton pump inhibitor dose, high-dose dual therapy, N-acetycysteine, linolenic acid and vonoprazan. These clinical, diagnostic and therapeutic uncertainties will represent fascinating challenges in the future.

中文翻译：

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幽门螺杆菌的球状形式之谜：超越基础科学。

幽门螺杆菌（幽门螺旋杆菌）可能会进入非复制性，不可培养，低代谢活性状态，即所谓的球状形式，以在极端环境条件下生存。由于类球体形式对抗生素不敏感，因此即使没有抗生素耐药性，也可能代表治疗失败的原因，即一年内复发。此外，类球体形式可能在动物模型中定植并感染胃粘膜，并在动物和人类中诱导特异性抗体。由于它们不可培养，因此很难检测到它们。即使目前的证据有限，诸如电子显微镜，聚合酶链反应，环介导的等温扩增，流式细胞术和宏基因组学等技术也是有希望的。在治疗方案中，有人提出了一些策略，例如质子泵抑制剂剂量很高，N-乙酰半胱氨酸，亚麻酸和vonoprazan。这些临床，诊断和治疗上的不确定性将在未来代表着令人着迷的挑战。