What Is H. Pylori?

Infection with the helicobacter pylori bacteria, usually referred to as H. pylori, is common, affecting almost half of all people in the United States at some point in their lifetime. In most cases, the infection doesn't cause symptoms; however, an H. pylori infection can cause peptic ulcers in some people. In rare cases, it can contribute to the development of stomach cancer.

If you have any signs or symptoms of a peptic ulcer, it's important to see a healthcare provider. Since H. pylori infections can cause peptic ulcers, treatment involves eliminating the infection with antibiotics and helping the stomach heal with antacids. Treating H. pylori infections also reduces the risk of developing stomach cancer.

H. Pylori Infection Symptoms

Most people with an H. pylori infection won’t have any symptoms. If the infection causes a peptic ulcer, you’ll then experience typical ulcer symptoms such as:

• Upper abdominal pain or discomfort

• Bloating and belching

• Feeling excessively full after eating, even after only a small amount of food

• Nausea or vomiting

• Loss of appetite

• Weight loss

What Causes an H. Pylori Infection?

There are a few ways H. pylori can enter the gastrointestinal system. The primary ways are ingesting bacteria through contaminated food or water and having close contact with the saliva or bodily fluids of a person who has an H. pylori infection.

Bacteria can cause changes to the protective lining of the stomach, which may lead to chronic inflammation. This inflammation makes the lining less protective. Over time, the stomach's exposure to digestive acids can result in a peptic ulcer.

Risk Factors

H. pylori bacteria can actually live inside you without causing symptoms. Many people have this bacteria in their bodies without it turning into an infection. Some people are more likely than others to develop an infection, including:

• People who smoke

• People with a family history of gastric cancer

• People with low socioeconomic status

• People living in undeveloped countries

• People who regularly take non-steroidal anti-inflammatory drugs (NSAIDs)

• People with well water, or who drink other sources of unfiltered water

• People living in crowded housing conditions

Diagnosis

If your healthcare provider thinks you have an H. pylori infection, they will perform a physical exam, ask you about your symptoms, and take a comprehensive family or medical history. From there, H. pylori can be fairly easily tested for and diagnosed through several different types of tests:

• Blood test: If you have H. pylori, your body sends antibodies throughout your body to help fight the infection. Your blood may be tested for the presence of H. pylori antibodies.

• Stool sample: Stool can be tested for H. pylori antigens (foreign cells that trigger an immune response) or cultured to test for the presence of the H. pylori bacteria.

• Breath test: This measures the level of carbon dioxide in your breath after swallowing a harmless substance known as urea; if your carbon dioxide levels are higher than normal after ingesting the urea, it indicates an H. pylori infection.

If necessary, more in-depth upper gastrointestinal testing such as endoscopy or X-ray may be required. During an endoscopy, your healthcare provider will take a biopsy (tissue sample) of your stomach lining and look at the tissue more closely under a microscope. An X-ray is a non-invasive imaging technique that can be used to detect ulcers and other complications.

Treatments for H. Pylori Infection

If your peptic ulcer is determined to be caused by H. pylori bacteria, you will likely be prescribed medications to eliminate the bacterial infection and heal the ulcer. This is done through a combination of antibiotics and acid-reducers.

To eliminate the H. pylori bacteria, most people require a combination of at least two antibiotics. The most commonly prescribed antibiotics for H. pylori are clarithromycin, metronidazole, and amoxicillin.

Your provider will likely also prescribe a proton pump inhibitor such as Prilosec or Nexium. Proton pump inhibitors reduce the amount of acid produced in the lining of your stomach, and may be taken for a few weeks at a time as part of your treatment plan. Sometimes, bismuth subsalicylate, an anti-diarrheal that can lower the amount of fluids and inflammation in the intestines, is also recommended.

To help the ulcer heal, your provider may prescribe a histamine blocker (also called an H2 blocker) medication like Pepcid AC (famotidine). H2 blockers limit the amount of acid produced by the histamine cells in your stomach.

Sometimes the H. pylori infection doesn’t go away with the first round of treatment and a second round is required. Your provider will likely test your breath or stool for H. pylori after you complete your initial treatment to see if follow-up treatment is necessary.

Prevention

H. pylori is very common and you may not be able to prevent ingesting the bacteria. But there are some simple ways you can reduce your risk, like practicing good hand hygiene (e.g. washing your hands after using the bathroom, eating or preparing food, or caring for sick people), eating food that has been prepared and cooked properly, and drinking clean sources of water.

You can also work to eliminate some of the common risk factors for H. pylori infections, such as not smoking and limiting the use of NSAIDs.

Complications of H. Pylori Infection

If you have inflammation from an untreated H. pylori infection, you may develop a peptic ulcer or chronic gastritis, a progressive inflammation of the stomach lining.

Less commonly, long-term H. pylori infections can also cause certain types of stomach cancer, like gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

Researchers aren’t sure, however, how much an H. pylori infection raises your risk for stomach cancer overall. The risk for gastric adenocarcinoma is higher for people with chronic H. pylori infections. Additionally, nearly all people with gastric MALT lymphoma (which is rare in the United States) have symptoms of an H. pylori infection and often see tumor shrinkage after undergoing antibiotic treatment for H. pylori.

A Quick Review

The H. pylori bacteria is prevalent in many parts of the world, and nearly half of all Americans will contract an H. pylori infection at some point. For many of these people, infection will be asymptomatic, but for some, the bacteria will disrupt the protective lining of the stomach and cause peptic ulcers. Treating H. pylori infections with antibiotics and acid-reducing medications can improve symptoms and reduce the risk of other complications, like gastric cancer.

Frequently Asked Questions

Who is prone to H. pylori?

People who smoke, live in crowded housing conditions, drink water from wells or other contaminated sources, take regular NSAIDs, have a low socioeconomic status or live in an underdeveloped country, and people with a family history of gastric cancer are all at a higher risk of developing an H. pylori infection.

What does poop with H. pylori look like?

Usually, H. pylori doesn’t cause many changes to your stool. If you’re experiencing complications from an H. pylori infection, your stool may become black, bloody, or tarry.

Why is it so difficult to get rid of H. pylori?

The H. pylori bacteria is adept at making itself at home in the lining of your stomach, protecting itself against the stomach acid that often destroys other types of bacteria; if left untreated, H. pylori can persist in the stomach lining indefinitely. It requires targeted treatment with antibiotics to eliminate it and since many people aren’t even aware they have the bacteria in their stomach, it’s unlikely that H. pylori will simply go away on its own.

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