Overview

Helicobacter pylori (H. pylori) is a common bacterium that lives in the lining of the stomach. It is one of the most widespread infections in the world, usually picked up in childhood, and most people who carry it have no symptoms.

In some people it causes stomach inflammation (gastritis) and stomach or duodenal ulcers, and over many years it raises the risk of stomach cancer. A simple breath or stool test can detect it, and a combination of medicines clears the infection in most people.

Symptoms

• Burning or gnawing pain in the upper belly, often when the stomach is empty
• Bloating, burping, or feeling full soon after eating
• Nausea or loss of appetite
• Tiredness from iron-deficiency anemia
• No symptoms at all in many people
• Warning signs that need urgent care: black or tarry stool, vomiting blood or material like coffee grounds, trouble swallowing, weight loss, or severe belly pain

Causes & Risk Factors

• Spread from person to person through saliva, vomit or stool
• Contaminated food or water
• Living in the same home as an infected person
• Crowded living conditions in childhood
• Growing up in an area where the infection is common
• A family history of stomach cancer, which is a reason to get tested

Complications

• Long-term gastritis
• Stomach or duodenal ulcers, which can bleed or cause a tear in the stomach wall
• Iron-deficiency anemia and low vitamin B12
• A higher long-term risk of stomach cancer
• A rare type of stomach lymphoma called MALT lymphoma

Diagnosis

The preferred tests for active infection are the urea breath test and the stool antigen test, while endoscopy with biopsy is used when warning signs are present. Blood antibody tests are not advised because they can stay positive after the infection is gone. For accurate results, acid-reducing medicines called proton pump inhibitors (PPIs) are usually stopped 2 weeks before testing, and antibiotics and bismuth 4 weeks before, on a doctor's advice. Testing is advised for people with ulcers, ongoing indigestion, long-term aspirin or anti-inflammatory painkiller use, unexplained iron-deficiency anemia, a family history of stomach cancer, or an infected household member.

Treatment

• Bismuth quadruple therapy for 14 days is the preferred first treatment in the ACG 2024 guideline: a PPI, bismuth, tetracycline and metronidazole
• Other options chosen by the doctor include a vonoprazan-based regimen or rifabutin-based triple therapy
• Clarithromycin-based therapy is used only when testing shows the bacteria are sensitive to it
• Taking every dose until the course ends is key to success
• Bismuth often turns stool dark or black, which is expected, but dizziness or vomiting blood needs urgent care
• In Ramadan, the course is planned with the doctor, since some regimens need doses several times a day
• A breath or stool test at least 4 weeks after finishing treatment confirms the infection is gone

Prevention

• Wash hands well before eating and after using the toilet
• Drink clean, safe water and eat well-cooked food
• Avoid sharing cups and eating utensils
• Test household members of an infected person when the doctor advises
• Confirm the infection has cleared after treatment to lower the chance of ulcers returning
• Avoid smoking and unnecessary anti-inflammatory painkillers, which add to stomach damage

The Internal Medicine and Laboratory departments at AlHayat Medical Center work together to test for H. pylori, treat it and confirm it has cleared.

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