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Helicobacter pylori Infection

(H. pylori Infection)


Nimish Vakil

, MD, University of Wisconsin School of Medicine and Public Health

Reviewed/Revised Mar 2023
Topic Resources
  • The infection is caused by a type of bacteria called Helicobacter pylori (H. pylori).

  • When symptoms of H. pylori infection do occur, they include indigestion and pain or discomfort in the upper abdomen.

  • Doctors often base the diagnosis on the results of a breath or stool test or on an examination of the stomach using a flexible viewing tube (upper endoscopy).

  • Treatment is with antibiotics and a proton pump inhibitor.

Infection with Helicobacter pylori is the most common cause of gastritis Gastritis Gastritis is inflammation of the stomach lining. The inflammation can be caused by many factors, including infection, stress resulting from severe illness, injury, use of aspirin and other nonsteroidal... read more Gastritis and peptic ulcer disease Peptic Ulcer Disease A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. Peptic ulcers can result from infection with Helicobacter... read more Peptic Ulcer Disease worldwide. Infection is very common and increases with age. By age 60, about 50% of people in the United States are infected. However, recent studies show fewer young people are becoming infected with H. pylori. Infection is most common among Black, Hispanic, and Asian people.

H. pylori infects the lining of the stomach and can also be found in stool, saliva, and plaque on the teeth. H. pylori can be transmitted from person to person, especially if people who are infected do not thoroughly wash their hands after a bowel movement. Because people may also spread the bacteria through kissing or other close contact, infections tend to cluster in families and among people who live in nursing homes and other supervised facilities.

Did You Know...

  • Certain bacteria, called Helicobacter pylori, are the most common cause of gastritis and peptic ulcers.

H. pylori bacteria grow in the protective mucus layer of the stomach lining, where they are less exposed to the highly acidic juices produced by the stomach. Additionally, H. pylori produces ammonia, which helps protect it from stomach acid and enables it to disrupt and penetrate the mucus layer.

The Stomach

Complications of H. pylori infection

Symptoms of H. pylori Infection

Many people whose gastritis is caused by H. pylori infection do not have symptoms or complications such as a peptic ulcer of the stomach or duodenum.

People who do develop symptoms resulting from H. pylori infection have those that are typical of gastritis, including indigestion Indigestion Indigestion is pain or discomfort in the upper abdomen. People may also describe the sensation as gassiness, a sense of fullness, or gnawing or burning. The sense of fullness may occur after... read more and pain or discomfort in the upper abdomen.

Ulcers caused by H. pylori infection cause symptoms similar to ulcers caused by other disorders, including pain in the upper abdomen.

Diagnosis of H. pylori Infection

  • Tests of breath or stool

  • Sometimes upper endoscopy

H. pylori can be detected with tests that use breath or stool samples.

Sometimes doctors use a flexible viewing tube (endoscope) to do an upper endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more to obtain a sample (biopsy) of the stomach lining. The sample can be tested for H. pylori by several methods.

Treatment of H. pylori Infection

  • Antibiotics and a proton pump inhibitor

  • After treatment, tests to confirm eradication of H. pylori infection

The most common treatment for H. pylori infection is a combination of a proton pump inhibitor Proton Pump Inhibitors Stomach acid plays a role in a number of disorders of the stomach, including peptic ulcer, gastritis, and gastroesophageal reflux disease (GERD). Although the amount of acid present in the stomach... read more to reduce stomach acid production, two antibiotics, and sometimes also bismuth subsalicylate. One of several proton pump inhibitors, lansoprazole, omeprazole, pantoprazole, rabeprazole, or esomeprazole, is given. These medications usually are well tolerated (have few or mild side effects), but may cause diarrhea, constipation, and headache. Several different antibiotics may be used, including amoxicillin, clarithromycin, metronidazole, and tetracycline. All of these antibiotics may alter taste and cause nausea, and amoxicillin, clarithromycin, and tetracycline may cause diarrhea. Bismuth subsalicylate may cause constipation and darkening of the tongue and stool.

Doctors typically confirm that treatment was successful by repeating breath or stool tests or endoscopy about 4 weeks after treatment is finished.

Treatment is repeated if H. pylori is not eradicated.

Prognosis for H. pylori Infection

If H. pylori infection is fully eradicated, there is a less than 10% chance a peptic ulcer will return within 3 years. If H. pylori infection is not fully eradicated, there is a greater than 50% chance a peptic ulcer will return in 3 years. In addition, treatment of H. pylori infection may heal ulcers that were not healed with previous treatment.

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