H. Pylori: Treatment Options

Sarah Bradley
·6 min read

Medically reviewed by Robert Burakoff, MD

Helicobacter pylori (H. pylori) bacteria infections are the primary cause of stomach ulcers, but many people with H. pylori don’t know they have it. H. pylori infections are usually asymptomatic, but if you have ulcer symptoms, it’s best to treat the infection and eliminate the bacteria. Prolonged ulcer symptoms can lead to complications, and having a chronic H. pylori infection can increase your risk for certain types of stomach cancer.

The good news is that it’s possible to treat H. pylori, heal any ulcers the infection has caused, and reduce your risk for complications and future illness. Medications like antibiotics and acid reducers are the frontline treatments for H. pylori. While it may take more than one round of treatment, H. pylori infections can be cured.

Medications

Medications are the primary treatment for H. pylori because it’s a bacterial infection of the stomach. You can’t eradicate the bacteria with diet or exercise, lifestyle changes, or other therapies.

The goal of medication treatment is twofold: to eliminate the H. pylori bacteria and to heal the parts of the stomach damaged by the bacteria, where one or more ulcers have formed. This is done through a combination of antibiotics, acid-reducers, and sometimes anti-diarrheal medications.

Antibiotics

Every treatment protocol for H. pylori will include two antibiotics. Because of the prevalence of antibiotic resistance (bacteria that no longer respond to antibiotic treatment) and the difficulty in eliminating H. pylori bacteria, taking two antibiotics gives you the best chance at clearing the infection.

The most commonly-prescribed antibiotics for treating H. pylori are clarithromycin, amoxicillin, and metronidazole. If those antibiotics fail to eliminate the infection—or if you have used them frequently in the past or have a history of resistance to any of them—your provider may choose to use tetracycline or levofloxacin instead. You will need to complete a 10- to 14-day course of these antibiotics.

These antibiotics are generally considered safe for most people, but common side effects include gastrointestinal upset (like nausea and diarrhea) and a metallic taste in the mouth.

At the end of treatment, your provider will likely retest you for H. pylori. About 80% of people don’t require any further treatment, but about 20% will need to repeat their treatment with some changes. In most cases, your provider will prescribe a different pair of antibiotics for you to take for 10 to 14 days, and may add in additional medications, like bismuth subsalicylate.

Anti-Diarrheal Medication

Bismuth subsalicylate is an anti-diarrheal medication often sold over-the-counter (OTC) as Kaopectate or Pepto-Bismol. When used as part of a treatment protocol for H. pylori, it can have bacteria-reducing and -suppressing effects, helping to rid the stomach of the bacteria and promote further healing of the area affected by the stomach ulcer.

Bismuth subsalicylate is not usually used as part of the frontline treatment for H. pylori, but it can be an important component for people needing re-treatment. It increases their chances of clearing the infection.

Acid Reducers

Alongside two antibiotics, most people receiving treatment for H. pylori will take a proton pump inhibitor (PPI), which is commonly referred to as an anti-reducer. These medications don’t have any effect on the bacteria, but they do help your stomach ulcer heal. PPIs reduce the amount of acid produced by your stomach. They are often taken for 14 days at a time.

Some PPIs are available by prescription and some can be bought OTC. Common PPIs include:

  • Prilosec (Omeprazole)

  • Nexium (Esomeprazole)

  • Prevacid (Lansoprazole)

  • Protonix (Pantoprazole)

PPIs don’t have many side effects, but some people may experience headaches or gastrointestinal upset. Prolonged use can increase your chance of bone fracture.

Surgery

Surgery is also usually not recommended to treat H. pylori, though is sometimes necessary to remove an ulcer that isn’t healing with other types of treatments.

In fact, the discovery that H. pylori is the most common cause of ulcers has actually reduced the need for surgery to treat them, according to several studies from the late 1990s; prior to that time, surgery to remove parts of the stomach suspected to have an H. pylori infection was often performed, but only eliminated the infection about 50% of the time.

Complementary and Alternative Medicine

For the most part, antibiotics and acid-reducing medications are the only treatment for H. pylori. But because antibiotic resistance continues to be a pressing issue in the practice of medicine today, some experts have studied the effect that probiotics have on H. pylori.

Though no studies support the use of probiotics as a substitute for standard treatment with antibiotics and PPIs, several studies suggest that adding probiotics to your treatment regimen may improve outcomes. Not only can probiotics strengthen your immune response in the gut (priming it to better fight off bacteria like H. pylori), they may have an antimicrobial effect on the bacteria itself, inhibiting its growth.

A 2022 review of studies finds that incorporating probiotics into standard H. pylori treatment may lead to better eradication of the bacteria, less treatment-related side effects (like diarrhea), and better overall compliance with the treatment.

Related: What's The Difference Between a Probiotic and Prebiotic?

Living With and Managing H. Pylori

If you test positive for H. pylori, your healthcare provider will recommend receiving treatment until the infection has fully cleared. Eliminating the H. pylori bacteria is the best way to improve your health outcomes, both in the short-term (i.e. healing your stomach ulcer and preventing future ulcers) and the long-term (reducing your risk of stomach bleeding and stomach cancer).

However, there is some debate about whether asymptomatic people who test positive for H. pylori should undergo the usual treatment regimen to get rid of the bacteria. Some experts say asymptomatic infections should be treated, while other experts say this often isn’t necessary. This is complicated by the fact that H. pylori testing usually isn’t performed unless you have stomach ulcer symptoms or a history of peptic ulcer disease, though sometimes routine testing is recommended for people with a family history or otherwise increased risk of stomach cancer.

If you test positive for H. pylori but don’t have any ulcer symptoms, you should discuss the pros and cons of treating your infection with your healthcare provider. Unless you have any reason not to take the typically-prescribed medications for treating H. pylori, your provider may recommend treatment to lower your future risk of illness and complications.

A Quick Review

H. pylori is a common bacterial infection that can be asymptomatic but can also cause stomach ulcers. Symptomatic people should follow the recommended treatment prescribed by their provider—usually a combination of antibiotics and acid reducers—in order to heal any existing ulcers, prevent new ones from forming, and avoid more serious complications like GI bleeding and cancer.

This treatment cures H. pylori quickly in the vast majority of people, with a small percentage needing to repeat the treatment in order to eliminate the bacteria fully.

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Read the original article on Health.