Patient Education

Helicobacter Pylori

What is H. pylori?

Helicobacter Pylori (H. pylori) is a type of bacteria primarily found in the stomach. More than half the world’s population is infected with H. pylori.  However, most people who are infected with H. pylori will never experience symptoms or develop problems.

H. pylori is a common cause of peptic ulcers, and in rare cases can lead to stomach cancer.  The transmission of H. pylori bacteria isn’t completely understood. Direct contact with bodily fluids and exposure to contaminated food or water may be the cause of H. pylori infection.

H. pylori infections can cause damage to the stomach and the first part of the small intestine (duodenum).  The bacteria affect the lining of the stomach and duodenum, making them more vulnerable to digestive fluids like stomach acid.  This can cause chronic inflammation of the stomach walls (gastritis) and duodenum (duodenitis).

Helicobacter pylori Symptoms

For most people, H. pylori will not cause any symptoms or problems.  It’s possible that some people are born with greater resistance to H. pylori’s harmful effects.

If a Helicobacter pylori infection does cause symptoms, they could include:

• Aching, burning, or pain in the abdomen
• Stomach pain, especially with an empty stomach
• feeling full after eating very little
• Nausea / Vomiting
• Lack of appetite
• Bloating
• Frequent belching
• Unexplained weight loss

These symptoms are common for many gastrointestinal conditions, and your doctor will help determine if your symptoms are caused by an H. pylori infection.

When to see a doctor right away

If you have any of the following symptoms that could be a sign of a bleeding ulcer, you should get medical help immediately:

• Abdominal pain so severe it wakes you from sleep
• Blood in the stool or black, tarry stools
• Difficulty breathing
• Dizziness, fainting
• Pale skin
• Unexplained fatigue
• Vomit that is black, has visible blood or looks like coffee grounds

Causes of H. pylori

The exact cause of how H. pylori infections spread is unknown.  Experts believe H. pylori is most likely spread by direct contact with bodily fluids – including saliva, vomit, or fecal matter. Ingesting contaminated food and water is also a strong possibility. It’s also not known how H. pylori cause gastritis or peptic ulcers.

H. pylori Risk Factors

Infection with H. pylori often occurs in childhood and is related to living conditions. The risk factors for H. pylori include:

• Living with Many Others – People who live in homes that are crowded are more likely to have H. pylori.
• Living without clean, reliable water – Access to a reliable, clean water source can reduce the risk of H. pylori.
• Living in a Developing Country – People who live in countries where it is more common to live in unsanitary and crowded conditions are at greater risk for H. pylori.
• Living with someone with H. pylori – People who live with someone who has H. pylori have a higher risk of H. pylori infection.

H. pylori Complications

Complications of H. pylori infection include:

• Peptic Ulcers – Roughly 10 percent of those with H. pylori will develop an ulcer.  H. pylori can damage the inner surface of the stomach or small intestine, allowing stomach acid to create ulcers.  Ulcers can be painful but can be treated with antibiotics if the cause is H. pylori.
• Gastritis – Gastritis occurs when the lining of the stomach becomes inflamed. H. pylori can irritate the stomach and cause gastritis.
• Stomach Cancer – Although very rare, there are some types of stomach cancers that an H. pylori infection is associated with.

Helicobacter pylori Testing & Diagnosis

There are several tests and procedures used to diagnose H. pylori.  The most common tests are:

Breath Test

In an H. pylori breath test, patients drink a special solution or take a pill containing tagged carbon molecules. These molecules release carbon when they come in contact with H. pylori in the stomach.  This carbon can be detected when you exhale.

Patients exhale into a bag and the doctor uses a device that detects the presence of carbon. Some acid-suppressing medications (PPIs), antibiotics, and bismuth subsalicylate (Pepto-Bismol) can affect the results and accuracy of this test.  Your doctor will ask you to stop taking these medications one to two weeks before your breath test.

Stool Tests

Stool tests can detect the proteins associated with H. pylori.  Just like the breath test, PPIs and bismuth subsalicylate can affect the accuracy of stool tests. Talk with your doctor if you’re taking these drugs prior to a stool test.

There are two types of stool tests. A stool antigen test is the most used. It looks for antigens (proteins) associated with H. pylori. A stool PCR test looks for H. pylori and indications of resistance to antibiotic treatments.

Blood Test

Blood tests may reveal evidence of Helicobacter pylori, but stool and breath tests are more helpful when diagnosing active infections of H. pylori.

Endoscopy

An upper gastrointestinal endoscopy is a type of test that uses a scope to view the throat, esophagus, stomach, and first section of the intestine (duodenum). Your doctor inserts a thin, flexible tube with a tiny camera on the end down your throat, allowing them to examine your digestive tract and take tissue samples to biopsy if needed. You’ll have sedation to keep you comfortable during the test.

Upper GI Series

An upper GI series is an X-ray of your upper gastrointestinal tract. To make your GI tract more visible on X-ray, you’ll drink a special liquid containing barium first.

Computed tomography (CT)

A CT is a type of scan that takes X-rays from different angles and creates a detailed image from them.

H. pylori Treatment

Treatment for Helicobacter pylori generally includes:

• Antibiotics – To reduce the number of H. pylori bacteria, doctors will often prescribe two antibiotics.  Two different antibiotics are used to help prevent drug resistance.
• An acid-suppressing drug – Suppressing acid can help allow the stomach lining to heal.  Medications that can suppress acid include:
  • PPIs – Proton Pump Inhibitors reduce the stomach’s ability to create acid. Name brand examples include Prilosec, (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole).
  • H-2 Blockers – These drugs block histamine which is needed to produce acid. Name brand examples include Tagamet (cimetidine) and Pepcid (famotidine).
  • Bismuth subsalicylate – Most commonly referred to as Pepto-Bismol, this drug coats and protects the stomach ulcer while it heals.

Up to 20 percent of patients will not be cured after the first treatment for H. pylori. Patients will usually undergo a second round of medications for two weeks.  At least one of the antibiotics used in the second treatment round will be different than the first.

H. pylori Treatment Follow-up

After treatment, repeat testing using stool or breath tests is used to ensure the infection has resolved.

Preventing H. pylori

You can help prevent H. pylori the same way you prevent other infections:

• Don’t accept food or water from anyone who hasn’t washed their hands first
• Don’t eat food that’s not cleaned or cooked properly
• Only drink water from sources you know are safe
• Wash your hands before preparing or eating food and after using the bathroom