Overview

Helicobacter pylori (H. pylori) is a type of bacteria that can infect the stomach and small intestine. It is one of the most common bacterial infections in the world, affecting nearly half of the global population. In many cases, H. pylori causes no noticeable symptoms, but in some individuals, it can lead to peptic ulcers, chronic gastritis, and even stomach cancer.

Most people are infected during childhood, and the bacteria can persist for years if left untreated. Fortunately, when properly diagnosed, H. pylori infections can be treated effectively with a combination of antibiotics and medications that reduce stomach acid.

Common Symptoms

Most H. pylori infections are asymptomatic. However, when symptoms occur—often due to the development of a peptic ulcer—they may include:

  • Burning or aching pain in the upper abdomen

  • Bloating or excessive belching

  • Feeling full after eating small amounts

  • Nausea or vomiting

  • Loss of appetite

  • Unintentional weight loss

These symptoms often become more pronounced when the stomach is empty, such as between meals or during the night.

Causes and Transmission

H. pylori bacteria are typically acquired through ingestion of contaminated food or water. Person-to-person transmission through saliva or other bodily fluids is also possible.

Once inside the body, H. pylori can survive the acidic environment of the stomach by producing enzymes that neutralize stomach acid. The bacteria then attach to the stomach lining, disrupting its protective layer and causing inflammation.

Risk Factors

Certain individuals are more likely to develop an H. pylori infection due to environmental and lifestyle factors:

  • Living in crowded or unsanitary conditions

  • Drinking unfiltered or contaminated water

  • Consuming undercooked or improperly prepared food

  • Low socioeconomic status

  • Having a family history of stomach cancer

  • Smoking or frequent use of NSAIDs (nonsteroidal anti-inflammatory drugs)

While many people may carry the bacteria without symptoms, these risk factors increase the likelihood of infection-related complications.

How It’s Diagnosed

To diagnose H. pylori, healthcare providers usually begin with a physical exam and medical history. Diagnostic tests may include:

  • Blood test: Detects antibodies to H. pylori

  • Stool antigen test: Checks for bacterial proteins in the stool

  • Urea breath test: Measures carbon dioxide after the patient drinks a urea solution—positive results indicate infection

  • Endoscopy with biopsy: Allows direct visualization and sampling of stomach lining (used in more complex cases)

  • X-ray imaging: Occasionally used to detect ulcers or structural damage

Accurate diagnosis is essential for proper treatment and to rule out other gastrointestinal conditions.

Treatment Options

Treatment for H. pylori typically involves a combination of medications aimed at eradicating the bacteria and healing the stomach lining.

1. Antibiotic Therapy To eliminate H. pylori, at least two antibiotics are prescribed simultaneously to prevent resistance:

  • Clarithromycin

  • Amoxicillin

  • Metronidazole

  • Tetracycline (in specific regimens)

2. Acid Reduction Therapy Reducing stomach acid allows the stomach lining to heal and enhances the effectiveness of antibiotics:

  • Proton pump inhibitors (PPIs): Omeprazole, esomeprazole, pantoprazole

  • H2-receptor blockers: Famotidine (Pepcid AC)

  • Bismuth subsalicylate: Sometimes included in quadruple therapy to protect the stomach lining and kill bacteria

3. Retesting After Treatment Because H. pylori can persist after initial treatment, a follow-up breath or stool test is usually recommended within four weeks to confirm the infection is gone.

Prevention Tips

While it’s not always possible to prevent H. pylori infection, several strategies can help reduce the risk:

  • Wash hands thoroughly after using the restroom and before preparing or eating food

  • Drink water from clean, safe sources

  • Ensure all food is cooked and stored properly

  • Avoid sharing eating utensils or drinks with others

  • Limit the use of NSAIDs if you are at high risk

  • Stop smoking, as it weakens the stomach lining and increases risk of complications

Following these practices can reduce both initial infection and recurrence after treatment.

Possible Complications

When left untreated, H. pylori infections can lead to serious health problems, including:

  • Peptic ulcers: Open sores that form in the stomach or duodenum

  • Gastritis: Chronic inflammation of the stomach lining

  • Gastrointestinal bleeding: From ulceration or erosion of the stomach lining

  • Stomach cancer: Including gastric adenocarcinoma and MALT lymphoma

  • Anemia: Due to chronic blood loss from ulcers

While stomach cancer is a rare outcome, the presence of chronic inflammation from H. pylori increases this risk, especially in those with a family history or other risk factors.

Living With H. Pylori

In many cases, people with H. pylori may not even know they are infected. However, once symptoms arise or complications are identified, treatment is essential.

After completing treatment, patients are typically advised to:

  • Avoid NSAIDs unless prescribed

  • Maintain a bland or low-acid diet while healing

  • Avoid tobacco and alcohol

  • Get retested to confirm eradication

With appropriate care and lifestyle modifications, most individuals recover fully and avoid recurrence.

Final Thoughts

H. pylori is a common and often silent infection that can have serious consequences if left untreated. While many people carry the bacteria without any symptoms, others may develop ulcers or even stomach cancer over time. The good news is that with proper diagnosis and a comprehensive treatment plan—including antibiotics and acid reducers—most infections can be cured.

If you experience symptoms such as persistent stomach pain, nausea, or unexplained weight loss, talk to your healthcare provider about testing for H. pylori.