Helicobacter Pylori
(H. pylori)
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Helicobacter Pylori (H. pylori) Overview
Helicobacter Pylori (H. pylori) Causes
Helicobacter Pylori (H. pylori) Symptoms
When to Seek Medical Care
Exams and Tests
Helicobacter Pylori (H. pylori) Treatment
Self-Care at Home
Prevention
Outlook
Synonyms and Keywords
Authors and Editors
Viewer Comments: Helicobacter Pylori - How Was Diagnosis Established
Helicobacter Pylori (H. pylori) Overview
Helicobacter pylori (H. pylori) is a type of bacteria responsible for widespread infection with more
than 50% of the world's population infected, even though 80% of those infected have no
symptoms. H. pylori infection is associated with low grade inflammation of the stomach and
duodenum (the first part of the small intestine that empties the stomach).
The bacteria has evolved to survive in the acidic environment of the stomach where enzymes
digest food. The H. pylori bacteria burrow into the cells of the stomach lining and cause low grade
inflammation. H. pylori is the most common cause of gastric ulcers and gastritis (gastro=stomach
+itis=inflammation). Ten percent of those infected may develop an ulcer. Also, those infected
have an increased risk of stomach cancer and lymphoma.
Interestingly, the presence of the bacteria may decrease the prevalence of esophagitis by
decreasing the amount of stomach acid that refluxes back into the esophagus. This in turn leads
to a decreased risk for esophageal cancer in those infected with H. pylori. Further, H. pylori
seems to decrease the risk of developing asthma and allergies.
H. pylori bacteria is found most frequently in underdeveloped countries; but with improved
economic conditions, the rate of infection in the population decreases. The infection rate in the
United States is between 20%-30%, however, it is higher in Hispanics, African Americans, and
the elderly.
Helicobacter Pylori (H. pylori) Causes
While the exact mode of transmission H. pylori is not known, it seems to be spread from person
to person by saliva, and most people who are infected become infected as children. It also has
the potential to be spread by fecal contamination. This may explain why the rate of infection is so
high in poorer countries and in socio-economic groups characterized by crowded living
conditions, poor sanitary conditions, and lack of clean water. Personal hygiene is also very
important since food preparers who may not perform adequate hand washing may be potential
sources of infection.
As mentioned above, most people who become infected do so in childhood. After being ingested,
the bacteria burrow through the protective mucosa that lines the stomach to attach to deeper
layers of the stomach, where they can reside for years without causing symptoms.
Helicobacter pylori (H. pylori) Symptoms
The majority of people who are infected with H. pylori are symptom and disease free.
For those who do have symptoms, gastritis and ulcers are the results of an H. pylori infection.
These illnesses are characterized by:
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upper abdominal pain;
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loss of appetite;
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nausea and vomiting ; and
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if severe enough, bleeding into the gastrointestinal tract.
Abdominal pain is usually described as a burning sensation in the central upper abdomen below
the ribs. It may be associated with bloating, burping, and loss of appetite. Often the symptoms
occur after eating, and many times patients waken in the early morning hours with abdominal
pain.
If there is enough inflammation, bleeding is possible from the stomach lining or from an ulcer, a
small crater-like area in which the inflammation has caused the protective lining of the stomach to
wear away. Symptoms of bleeding include vomiting blood and passing black, tarry stools. The
black stools are a result of blood that has been metabolized and partially digested.
Note: that iron and bismuth subsalicylate (Pepto-Bismol, Pink Bismuth) will also turn the stools
black.
When to Seek Medical Care
It is always appropriate to see your health care provider for abdominal pain. Diseases of many
organs in the abdomen can present with upper abdominal pain, nausea, and vomiting. For
example, gallbladder, liver, pancreas, and kidney ailments may have abdominal pain as the
presenting symptom. As well, upper abdominal pain and nausea may be an atypical presentation
of angina, or pain from coronary artery disease.
Vomiting blood or passing black, tarry, or bloody stools are medical emergencies and should not
be ignored. Accessing care at an emergency department or by activating the emergency medical
system (call 911 if available) is appropriate. Sudden, severe pain is also an indication to seek
urgent or emergent care.
Exams and Tests
Testing for the H. pylori infection may be performed on blood, stool, or breath samples. Also,
biopsies or small bits of tissue from the lining of the gastrointestinal tract obtained during
endoscopy can be tested for the presence of H. pylori.
Usually this testing is done after the diagnosis of gastritis or ulcer is made. Diagnosis depends
upon the health care practitioner taking a patient history and asking specific questions. Aside
from the infection, there are other, lifestyle-related causes of gastritis and ulcers including
smoking, alcohol consumption, and nonsteroidal anti-inflammatory medication use (aspirin,
ibuprofen, naproxen).
Physical examination will yield more information regarding the diagnosis of abdominal pain. In
addition to examining the abdomen, a rectal examination may be performed to test for blood in
the stool.
In addition to testing to testing for the presence of the H. pylori bacteria, other blood tests may be
performed to screen for anemia (low red blood cell count ) and other diseases. A urine sample
may be taken to look for infection.
If there is a concern that an ulcer is present, arrangements may be made for a consultation with a
gastroenterologist and possible endoscopy, in which the gastroenterologist uses a thin tube
containing a camera to examine the lining of the esophagus, stomach, and duodenum.
Alternatively, an upper GI series may be performed to look for an ulcer. In this test, x-rays of the
abdomen are taken after the patient swallows barium or another type of contrast material. If a
gastric ulcer is found, endoscopy is usually recommended, since some ulcers have the potential
to become cancerous. Ulcers in the duodenum typically do not have this potential.
Helicobacter pylori (H. pylori) Treatment
The therapy for Helicobacter pylori infection involves multiple steps. In addition to antibiotics to
eradicate the bacteria, another goal is to decrease the amount of acid secretion in the stomach
and remove risk factors for further stomach irritation.
Antibiotic therapy
A two week course of combination antibiotic therapy is recommended.
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clarithromycin (Biaxin)
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metronidazole (Flagyl)
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tetracycline (Achromycin)
Antacid therapy
Proton pump inhibitors and H2 blocker medications decrease acid secretion in the stomach and
are often prescribed for a minimum of two weeks.
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Proton pump inhibitors
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lansoprazole (Prevacid)
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omeprazole (Prilosec)
H2 blocker
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ranitidine (Zantac)
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famotidine (Pepcid)
Bismuth therapy with Pepto- Bismol is sometimes recommended, especially if the first round of
antibiotic therapy failed. Please remember that this treatment will cause stools to turn black.
Behavioral modification
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Avoid alcohol
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Take aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve) only with approval of your health
care provider
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Stop smoking
Self-Care at Home
Abdominal pain should always be of concern. Emergency care should be accessed if it is sudden
in onset, associated with chest pain and shortness of breath, or if you have bloody vomit or
bloody or black tarry stools.
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Prevention of an H. pylori infection is the best way to prevent associated disease and
depends on goods hygiene and hand washing, especially with food preparation.
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Once H. pylori has been diagnosed, it is important to complete the full course of antibiotic
and acid blocker therapy to maximize the potential for a cure.
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Minimizing irritation to the stomach lining will decrease the risk of gastritis and ulcer,
though not the risk of H. pylori infection.
Prevention
Personal hygiene is the first step in decreasing human to human transmission. This is especially
important for those involved in food preparation, either in the home or in public places. Vaccines
to prevent the infection are being developed but are still in the research phase and not available
for human use.
Helicobacter pylori is a worldwide epidemic, and the bacteria have infected humans for thousands
of years. It is seen more frequently in populations afflicted with poverty and lack of access to
clean water and sewage removal. Increasing basic living standards and providing clean water
should decrease the potential for infection.
Outlook
The diagnosis of Helicobacter pylori infection usually follows the diagnosis of gastritis or ulcer
disease. With adequate antibiotic therapy, the bacteria should be eradicated and the risk of future
complications decreased. While the infection may be gone, it is important to continue behavioral
modification to prevent stomach inflammation from non-infectious causes.
Synonyms and Keywords
Helicobacter pylori infection, Hp, H. pylori infection, antral gastritis, type B gastritis, autoimmune
gastritis, type A gastritis, peptic ulcer disease, PUD, Helicobacter pylori-associated
gastroduodenal disease, Hp-associated gastroduodenal disease, duodenal ulcer, GI tract
infection, mucosa-associated lymphoma, mucosa-associated lymphoid tissue disease,
Campylobacter pylori, C pylori, gastric lymphoma, adenocarcinoma, recurrent abdominal pain
Authors and Editors
Author: Benjamin C. Wedro, MD, FAAEM
Editor: Melissa Conrad Stöppler, MD
Last Editorial Review: 11/21/2008