Helicobacter pylori infection
H pylori infection
Helicobacter pylori (H pylori) is a type of bacteria that infects the stomach. It is very common, affecting about two thirds of the world's population. H pylori infection is the most common cause of peptic ulcers. However, the infection does not cause problems for most people.
If you've got stomach pain and nausea, any number of gastrointestinal problems could be to blame. When these symptoms don't go away, one possibility is that you have a peptic ulcer. Let's talk about peptic ulcers. A peptic ulcer is a defect in the lining of your stomach or the first part of your small intestine, the duodenum. When the defect is in your stomach, it's called a gastric ulcer. A defect in your duodenum is called a duodenal ulcer. Your stomach is filled with strong acid, which breaks down and digests the foods you eat. If you've ever seen a strong acid at work, you know that it starts to burn away anything it touches. That's why your stomach and intestines are equipped with a special lining to protect them. But if that lining breaks down for any reason, acids can start eating their way through. When acids burn a hole all the way through the stomach or duodenum, it's called a perforation, and that's a medical emergency. You may joke that your boss is giving you an ulcer, and it's possible that stress does play some part in ulcers. More likely, your ulcer is caused by a stomach infection with a type of bacteria called H. pylori. Other common ulcer risks include smoking cigarettes, drinking a lot of alcohol, or regularly using NSAID pain relievers like aspirin and ibuprofen. If the ulcer is small, you may have no idea that you have it because there are no symptoms. Larger ulcers can cause abdominal pain, a feeling of fullness in the stomach, and nausea. If you have any of these ongoing symptoms, your doctor will look inside your GI tract to see what's going on. One way to do this is with an upper endoscopy, a thin tube with a camera on one end that takes pictures as it moves through your stomach and small intestine. An upper GI is a series of x-rays that are taken after you drink a substance called barium. Your doctor will also test you for the H. pylori bacteria that may be causing your ulcer. Treatment for peptic ulcers works in two ways. If you have an H. pylori infection, you'll have a medication regimen to kill the bacteria. You'll also get a medicine called a proton pump inhibitor, such as Prilosec or Prevacid, which reduces the amount of acid in your stomach. Try to avoid taking NSAID pain relievers for long periods of time, especially if you have a problem with H. pylori. Use Tylenol instead. If you do have to take NSAIDs, also take an acid-blocking drug to protect your sensitive stomach. Also avoid tobacco smoke and excess alcohol. Follow your doctor's instructions carefully for treating a peptic ulcer. If you don't follow your treatment as directed, your ulcer could easily come back. Call your doctor right away if you have sharp stomach pain, if you're sweating a lot or feeling confused, or your stomach feels hard to the touch. These could be signs of a serious ulcer complication that needs immediate medical help.
The stomach is the portion of the digestive system most responsible for breaking down food. The lower esophageal sphincter at the top of the stomach regulates food passing from the esophagus into the stomach, and prevents the contents of the stomach from reentering the esophagus. The pyloric sphincter at the bottom of the stomach governs the passage of food out of the stomach into the small intestine.
Esophagogastroduodenoscopy (EGD) is a test procedure to examine the lining of the esophagus, stomach, and first part of the small intestine. The procedure uses an endoscope. This is a flexible tube with a light and camera at the end. A biopsy can be taken through the endoscope of any suspicious areas that are seen.
A peptic ulcer is an open sore or raw area in the lining of the stomach (gastric) or the upper part of the small intestine (duodenal).
Causes
H pylori bacteria are most likely passed directly from person to person. This tends to happen during childhood. The infection remains throughout life if not treated.
It's not clear how the bacteria are passed from one person to another. The bacteria may spread from:
- Mouth-to-mouth contact
- GI tract illness (particularly when vomiting occurs)
- Contact with stool (fecal material)
- Contaminated food and water
The bacteria may trigger ulcers in the following way:
- H pylori enters the mucus layer of the stomach and attaches to the stomach lining.
- H pylori cause the stomach to produce more stomach acid. This damages the stomach lining, leading to ulcers in some people.
Besides ulcers, H pylori bacteria can also cause a chronic inflammation in the stomach (gastritis) or the upper part of the small intestine (duodenitis) and duodenal ulcers.
H pylori can also sometimes lead to stomach cancer or a rare type of stomach lymphoma.
Symptoms
About 10% to 15% of people infected with H pylori develop peptic ulcer disease. Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.
An aching or burning pain in your abdomen is a common symptom. The pain may be worse with an empty stomach. The pain can differ from person to person, and some people have no pain.
Other symptoms include:
- Feeling of fullness or bloating and problems drinking as much fluid as usual
- Hunger and an empty feeling in the stomach, often 1 to 3 hours after a meal
- Mild nausea that may go away with vomiting
- Loss of appetite
- Weight loss without trying
- Burping
- Bloody or dark, tarry stools or bloody vomit
Exams and Tests
Your health care provider may test you for H pylori if you:
- Have peptic ulcers or a history of ulcers
- Have discomfort and pain in the stomach lasting more than a month
Tell your provider about the medicines you take. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also cause ulcers. If you have an ulcer or show symptoms of an H pylori infection, your provider may perform the following tests for H pylori
- Breath test -- urea breath test (Carbon Isotope-urea Breath Test, or UBT). Your provider will ask you to swallow a special substance that has urea. If H pylori are present, the bacteria turn the urea into carbon dioxide. This is detected and recorded in your exhaled breath after 10 minutes.
- Blood test-- measures antibodies to H pylori in your blood.
- Stool test -- detects the presence of H pylori in your stool.
- Biopsy -- tests a tissue sample taken from the stomach lining using endoscopy. The sample is checked for H pylori infection.
Treatment
In order for your ulcer to heal and to reduce the chance it will come back, you will be given medicines to:
- Kill the H pylori bacteria (if present)
- Reduce acid levels in your stomach
Take all of your medicines as you have been told. Other lifestyle changes can also help.
If you have a peptic ulcer and an H pylori infection, treatment is recommended. The standard treatment involves different combinations of the following medicines for 10 to 14 days:
- Antibiotics to kill H pylori
- Proton pump inhibitors to help lower acid levels in the stomach
- Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria
Taking all of these medicines for up to 14 days is not easy. But doing so gives you the best chance for getting rid of the H pylori bacteria and preventing ulcers in the future.
Outlook (Prognosis)
If you take your medicines, there is a good chance that the H pylori infection will be cured. You will be much less likely to get another ulcer.
Sometimes, H pylori can be hard to fully cure. Repeated courses of different treatments may be needed. A stomach biopsy will sometimes be done to test the germ to see which antibiotic might work best. This can help guide future treatment. In some cases, H pylori can't be cured with any therapy, though the symptoms may be reduced.
If cured, reinfection may occur in areas where sanitary conditions are poor.
Posssible Complications
A chronic infection with H pylori may lead to:
- Peptic ulcer disease
- Chronic inflammation
- Gastric and upper intestine ulcers
- Stomach cancer
- Gastric mucosa-associated lymphoid tissue (MALT) lymphoma
Other complications may include:
- Severe blood loss
- Scarring from an ulcer may make it harder for the stomach to empty
- Perforation or hole of the stomach and intestines
- Iron deficiency anemia
When to Contact a Medical Professional
Severe symptoms that begin suddenly may indicate a blockage in the intestine, perforation, or hemorrhage, all of which are emergencies. Symptoms may include:
- Tarry, black, or bloody stools
- Severe vomiting, which may include blood or a substance with the appearance of coffee grounds (a sign of a serious hemorrhage) or the entire stomach contents (a sign of intestinal obstruction)
- Severe abdominal pain, with or without vomiting or evidence of blood
Anyone who has any of these symptoms should go to the emergency room right away.
References
Chan FKL, Lau JYW. Peptic ulcer disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 53.
Cover TL, Blaser MJ. Helicobacter pylori and other gastric Helicobacter species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 217.
Ku GY, Ilson DH. Cancer of the stomach. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 72.
Version Info
Last reviewed on: 3/31/2024
Reviewed by: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
