Shreeju Shrestha, M.S.N., APRN, FNP-BC
Internal Medicine – Digestive and Liver Diseases
Helicobacter pylori, or H. pylori, are common bacteria that infect billions of people worldwide. They are the leading cause of ulcers and gastritis (inflammation of the stomach lining). But approximately 80% of infected people worldwide will never develop symptoms – a phenomenon that researchers are still learning about.
H. pylori live in the digestive tracts of approximately two thirds of the world’s population, including one third of people in the U.S. The bacteria produce the enzyme urea, which neutralizes gastric acid in the stomach.
Over time, urea breaks down the stomach lining, causing gastritis and ulcers – painful, nonhealing wounds in the stomach lining. If left untreated, chronic gastritis can increase the risk of stomach cancer.
Infection typically occurs during childhood – in the U.S., fewer than 5% of children younger than 10 carry the bacteria. Infection is more common in developing countries with fewer water and food safety restrictions. Person-to-person transmission can occur through contact with an infected person’s fecal material, stomach contents, or mouth.
While approximately 5 billion people worldwide have H. pylori bacteria in their stomach, only about 20% of infected people have noticeable symptoms such as:
- Aching or burning stomach pain
- Bloating
- Frequent burping
- Loss of appetite
- Nausea
- Unintentional weight loss
Though H. pylori infection can’t be prevented, it is treatable with antibiotics. Using common sense approaches to food safety and interpersonal contact – and getting care when you notice symptoms – can help reduce your risk of infection and serious complications.
How H. pylori is diagnosed
H. pylori symptoms can initially seem similar to gastrointestinal reflux disease (GERD) and other digestive conditions. To determine whether your symptoms are caused by H. pylori, your doctor will use one of three tests to check for the presence of the bacteria in your stomach:
- Breath tests are the least invasive option and involve drinking a liquid solution and then blowing into a bag, which we check for the presence of urea. If urea is present, your symptoms may be caused by an H. pylori infection.
- Fecal stool tests are minimally invasive and involve examining a stool sample for proteins associated with H. pylori (called an antigen test).
- Upper endoscopies are typically only recommended for patients with severe symptoms, or when other test results are inconclusive. After providing a sedative to help you relax (you’ll be awake but you won’t remember the exam, like a colonoscopy), the doctor then threads a long, flexible tube with a tiny camera down the esophagus into the stomach. This allows the doctor to see any problems in the stomach and take a tissue sample, or biopsy, which is analyzed for the presence of H. pylori.
Testing may be repeated after treatment to confirm the bacteria have been eliminated. Some patients appear to have a natural resistance to H. pylori infection. More research is needed to understand why some people are more susceptible to developing ulcers or gastritis due to these bacteria.
Related reading: Gut health hacks on TikTok: What really works to improve digestive function
Treating H. pylori infections
For patients who develop symptoms, H. pylori infection is treatable with antibiotics that are designed to kill bacteria.
Usually, we prescribe a three- or four-drug course – combining medications has proven effective in getting rid of the bacteria. These courses include one or two antibiotics like amoxicillin, clarithromycin, metronidazole, and tetracycline.
Most patients also take a proton pump inhibitor (PPI) medication, which reduces the stomach’s ability to produce acid. PPIs include lansoprazole, omeprazole, and others. Sometimes doctors also prescribe bismuth subsalicylate (Pepto-Bismol) to help protect the stomach lining.
Patients take the medications for approximately 14 days. Side effects can include abdominal pain, diarrhea, and headache. It is important to finish taking all the medications to ensure the bacteria are fully controlled.
About 20% of patients have antibiotic-resistant H. pylori, which require re-treatment with higher doses of medication for a longer period. UT Southwestern offers the latest treatments for antibiotic-resistant H. pylori infection. Advanced oral medications are designed to eliminate bacteria and protozoa – small lifeforms that can cause severe diarrhea and inflammation.
Tips to reduce the risk of infection
Preventative measures to keep bacteria from entering your body include washing your hands thoroughly for at least 20 seconds after using the toilet and before eating. H. pylori has been found in raw food samples, so reduce your chances of encountering H. pylori bacteria by practicing proper food hygiene. This includes steps such as:
- Cleaning cutting boards, counter tops, and dishes with hot, soapy water when they are soiled
- Using hot, soapy water and paper towels or clean cloths when wiping kitchen spills and surfaces
- Washing cloths often in the hot cycle on the washing machine
- Washing cooking surfaces and utensils often with hot, soapy water
If you don’t have access to a source of safe drinking water, the Centers for Disease Control and Prevent (CDC) recommends boiling it for 1-3 minutes to kill bacteria, viruses, and parasites. Allow the water to cool before drinking. Boiled water can be stored in a sanitary container with a tight lid.
Don’t ignore gastric symptoms
Studies show most people on earth have H. pylori bacteria in their body. There are more than 1,000 other species of bacteria living in the human gut, too, and most of these get along with us and each other very well.
If you’re not experiencing symptoms, there’s no need to worry. But if you do have chronic gastritis or gut pain, talk with your doctor – most conditions that cause digestive symptoms can be safely treated, and getting the right care can help reduce your risk of complications from long-term infection.
To talk with a digestive health expert, call 214-645-8300 or request an appointment online.
