H. Pylori Infection
Written by Helen Colledge and Jacquelyn Cafasso
What is an H. pylori infection?
H. pylori are spiral-shaped bacteria that grow in the digestive tract and have a tendency to attack the stomach lining. H. pylori infections are usually harmless, but they’re responsible for the majority of ulcers in the stomach and small intestine.
H. pylori is a common type of bacteria that usually infects the stomach. They may be present in more than half of all people in the world, according to the Mayo Clinic. The “H” in the name is short for Helicobacter. “Helico” means spiral. The bacteria are spiral shaped.
H. pylori normally infect your stomach during childhood. While infections with this strain of bacteria typically don’t cause symptoms, they can lead to diseases in some people, including peptic ulcers, and an inflammatory condition inside your stomach known as gastritis.
H. pylori are adapted to live in the harsh, acidic environment of the stomach. These bacteria can change the environment around them and reduce its acidity so they can survive. The shape of H. pylori allows them to penetrate your stomach lining, where they’re protected by mucus and your body’s immune cells are not able to reach them. The bacteria can interfere with your immune response and ensure that they’re not destroyed. This can lead to stomach problems.
It’s still not known exactly how H. pylori infections spread. The bacteria have coexisted with humans for many thousands of years. The infections are thought to spread from one person’s mouth to another. They may also be transferred from feces to the mouth. This can happen when a person does not wash their hands thoroughly after using the bathroom. H. pylori can also spread through contact with contaminated water or food.
The bacteria are believed to cause stomach problems when they penetrate the stomach’s mucous lining and generate substances that neutralize stomach acids. This makes the stomach cells more vulnerable to the harsh acids. Stomach acid and H. pylori together irritate the stomach lining and may cause sores or peptic ulcers in your stomach or duodenum, which is the first part of your small intestine.
Children are more likely to develop an H. pylori infection. Their risk is higher mostly due to lack of proper hygiene.
Your risk for the infection partly depends on your environment and living conditions. Your risk is higher if you:
live in a developing country
share housing with others who are infected with H. pylori
live in overcrowded housing
have no access to hot water, which can help to keep areas clean and free from bacteria
It’s now understood that peptic ulcers are not caused by stress or eating foods high in acid, but they’re actually caused by this type of bacteria. About 10 percent of people infected with H. pylori develop a peptic ulcer, according to the Mayo Clinic. Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) also increases your risk of getting a peptic ulcer.
Most people with H. pylori don’t have any symptoms.
When the infection leads to an ulcer, symptoms may include abdominal pain, especially when your stomach is empty at night or a few hours after meals. The pain is usually described as a gnawing pain, and it may come and go. Eating or taking antacid drugs may relieve this pain.
If you have this type of pain or a strong pain that doesn’t seem to go away, you should visit your doctor.
A number of other symptoms may be associated with H. pylori infection, including:
nausea or vomiting
lack of appetite, or anorexia
unexplained weight loss
However, these are common symptoms that could be caused by other conditions. Some of the symptoms of H. pylori infection are also experienced by healthy people. These symptoms are common, but if any of them persist or you’re concerned about them, it’s always best to see your doctor. If you notice blood or a black color in your feces or vomit, you should consult your doctor.
Your doctor will ask about your medical history and family history of disease. Be sure to tell your doctor about any medications you’re taking, including any vitamins or supplements. If you’re experiencing symptoms of a peptic ulcer, your doctor will likely ask you specifically about your use of NSAIDs, such as ibuprofen.
Your doctor may also perform many other tests and procedures to help confirm their diagnosis:
During a physical exam, your doctor will examine your stomach to check for signs of bloating, tenderness, or pain. They’ll also listen for any sounds within the abdomen.
A stool sample may be needed to check for signs of H. pylori in your feces. Your doctor will give you a container to take home with you to catch and store a sample of your stool. Once you return the container to your healthcare provider, they will send the sample to a laboratory for analysis.
If you have a breath test, you’ll swallow a preparation containing urea. If H. pylori bacteria are present, they will release an enzyme that breaks down this combination and will release carbon dioxide, which a special device then detects.
If you have an endoscopy, your doctor will insert a long, thin instrument called an endoscope into your mouth and down into your stomach and duodenum. An attached camera will send back images on a monitor for your doctor to view. Any abnormal areas will be inspected, and special tools used with the endoscope will take samples from these areas if that’s necessary.
H. pylori infections can lead to peptic ulcers, but the infection or the ulcer itself can lead to more serious complications. These include:
internal bleeding, which can happen when a peptic ulcer breaks through your blood vessel
obstruction, which can happen when an ulcer blocks the food from leaving your stomach
perforation, which can happen when an ulcer breaks through your stomach wall
peritonitis, which is an infection of the peritoneum, or the lining of the abdominal cavity
Studies show that infected people also have an increased risk of gastric adenocarcinoma, which is a type of stomach cancer. While the infection is a major cause of stomach cancer, most people infected with H. pylori never develop stomach cancer.
If you have an H. pylori infection that isn’t causing you any problems and you aren’t at increased risk of stomach cancer, treatment may not offer any benefits.
Stomach cancer, along with duodenal and stomach ulcers, is associated with H. pylori infection. If you have close relatives with stomach cancer or a problem such as a stomach or duodenal ulcer, your doctor may want you to have treatment. Treatment can cure an ulcer, and it may reduce your risk of developing stomach cancer.
You will normally need to take a combination of two different antibiotics, together with another drug that reduces your stomach acid. Lowering stomach acid helps the antibiotics work more effectively. This treatment is sometimes referred to as triple therapy.
Some of the drugs that are used in a triple therapy treatment include:
proton-pump inhibitors (PPI), such as pantoprazole (Prevacid), esomeprazole (Nexium), pantoprazole (Protonix), or rabeprazole (AcipHex)
metronidazole (for seven to 14 days)
amoxicillin (for seven to 14 days)
Treatment may vary depending on your past medical history and if you have allergies to any of these medications.
After treatment, you will have a follow-up test for H. pylori. In most cases, only one round of antibiotics is needed to clear the infection, but you might need to take more, using different drugs.
Lifestyle and diet
There’s s no evidence that food and nutrition play a role in preventing or causing peptic ulcer disease in people infected with H. pylori. However, spicy foods, alcohol, and smoking may worsen a peptic ulcer and prevent it from healing properly.
For many people infected with H. pylori, their infections never cause any difficulties. If you’re experiencing symptoms and receive treatment, your long-term outlook is usually positive.
For those who develop diseases associated with an H. Pylori infection, the outlook will depend on the problem, how soon it’s diagnosed, and how it’s treated. You may need to take more than one round of treatment to kill the H. pylori bacteria. If the infection is still present after one round of treatment, a peptic ulcer could return or, more rarely, stomach cancer could develop. Very few people infected with H. pylori will develop stomach cancer. However, if you have a family history of stomach cancer, you should get testing and treatment for an H. pylori infection.