Gastro Health

A Patient's Guide to Helicobacter Pylori Infection

Written by
Dr. Davie Wong
and medically reviewed by Dr. Sneha Kannan

Published on Mar 21, 2019   -  3 min read



Helicobacter pylori (H.pylori) is a bacteria that infects your stomach. Approximately 50% of the world's population has been estimated to be infected.

A Patient's Guide to Helicobacter Pylori Infection


Helicobacter pylori (H.pylori) is a bacteria that infects your stomach. Approximately 50% of the world's population has been estimated to be infected. Many people have had the infection for a long time, but do not know that they are infected. Most of the time, H.pylori infection does not cause any problems or symptoms.

However, in some people, it can cause gastritis (inflammation of the stomach), ulcers on the lining of the stomach or duodenum, bleeding in the stomach or duodenum and rarely, stomach cancer. Symptoms can include pain or discomfort in the abdomen, early satiety (feeling full quickly after eating), loss of appetite, nausea or vomiting, very dark or black stools, excessive tiredness. H.pylori is thought to be transmitted from person to person through either fecal or oral route.

How Is H.Pylori Infection Diagnosed?

Several tests can be done to diagnosis H.pylori infection.

  • Blood tests detect the antibody against the bacterium. A positive test means your body has been exposed to H.pylori at some point in your life, but it does not necessarily mean you have an active infection.
  • Breath tests measure substances in your breath after you have been given a special liquid to drink to look for active infection.
  • Stool tests require a sample of your bowel movement, which can identify active infection.
  • A stomach biopsy involves taking a small piece of tissue from the lining of the stomach. This is done during a procedure called an endoscopy, where an instrument is inserted into your mouth, esophagus, stomach, and small intestines to look for abnormalities.

Not all of these tests are required to make a diagnosis. Your doctor will decide which tests you require.

Should I Get Tested for H.Pylori Infection?

You should get tested for H.pylori if you have a history of stomach cancer or ulcers. Other unexplainable symptoms and signs that may warrant testing include:

  • Unintentional weight loss.
  • Trouble swallowing.
  • Pain with swallowing.
  • Low iron levels.
  • Persistent vomiting.
  • Abdominal pain.
  • Heart burn.
  • Bloating.

If you do not have symptoms, it is not necessary to get tested. Testing is also generally not required even if you have a family member who has been diagnosed with H.pylori infection.

What is the treatment?

H.pylori infection is treated with a combination of drugs. Most people need to take 3 or more medications for 2 weeks to eradicate the infection. Generally, 2 types of oral antibiotics are given because this bacteria is difficult to eradicate with a single antibiotic. A third medication called a proton pump inhibitor is used to reduce the amount of acid that the stomach makes. This can help cure the infection and help ulcers heal. Sometimes a 4th medication called bismuth is added to the treatment regimen.

The purpose of treating this infection is to help the ulcers heal, prevent recurrent ulcers from developing, minimize the risk of the ulcer getting worse, prevent stomach cancer and improve your symptoms. It is very important to take the medications everyday and not to miss any doses. Because you are taking several medications at the same time, it is expected you may have some side effects such as nausea, vomiting or diarrhea. Tell your doctor if you develop these symptoms while on treatment. Some of the treatment regimens are listed below:

  1. Quadruple therapy - Tetracycline, Metronidazole, Bismuth, and Proton pump inhibitor.
  2. Triple therapy - Amoxicillin, Clarithromycin, and Proton pump inhibitor or Levofloxacin, Amoxicillin, and Proton pump inhibitor.

What Happens After Treatment?

Most people will be cured of the infection after completing treatment. Four weeks after you finish your treatment, a breath test, stool test or a stomach biopsy is required to confirm eradication of the infection. You must stop taking certain medications such as antibiotics and anti-acid drugs before doing some of these tests as they can affect the results.

Unfortunately, about 20 % of patients do not achieve successful eradication after an initial treatment course. Therefore, a second course of treatment is required, using different antibiotics from the first course. If treatment is still unsuccessful after the second course, then you may need to see a gastroenterologist to have an endoscopy to obtain samples from your stomach or intestines to try to grow the bacteria in the lab to determine which antibiotics will work against it.

Do not try more than two courses of treatment without seeing a specialist because the bacteria can become resistant to antibiotics with each treatment course.

What Can I Do to Prevent Myself from Getting H. Pylori Infection Again in the Future?

To minimize the risk of getting infected again, try these strategies.

  1. Wash your hands after using the washroom and before you prepare or eat food.
  2. Avoid unclean food and water.
  3. Do not eat undercooked foods.
  4. Avoid food prepared or served by people who do not wash their hands.
Last reviewed at:
21 Mar 2019  -  3 min read


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