Table of ContentsView AllTable of ContentsTransmissionSymptomsComplicationsTriggersAntibioticsSupportive CareRecoveryPrevention
Table of ContentsView All
View All
Table of Contents
Transmission
Symptoms
Complications
Triggers
Antibiotics
Supportive Care
Recovery
Prevention
Helicobacter pylori(H. pylori) is a corkscrew-shaped bacterium that infects the stomach. The bacterial infection can easily be passed from person to person. It is thought to affect around one-third of the U.S. population, most of whom are asymptomatic (without symptoms).
For some, H. pylori can cause symptoms of gastritis (stomach inflammation), including stomach pain, heartburn, and indigestion. H. pylori is also the primary cause of peptic ulcers and a contributing factor to stomach cancer.
While the infection can be cleared with a combination of antibiotic drugs, H. pylori is prone to antibiotic resistance and may require several attempts before all the bacteria are fully cleared.
How Is H. Pylori Transmitted?
H. pylori is one of the most transmittable types of bacteria, affecting up to two-thirds of the world’s population. It’s most common in developing countries where public sanitation is poor.Most infections occur during childhood, although some can develop well into adulthood.
H. pylori is easily passed through direct or indirect contact withsaliva,feces, ordental plaque.Possible routes of transmission include:
H. pylori has unique features that increase its contagiousness. These include its corkscrew shape, allowing the bacterium to burrow into the stomach lining. It also secretes a substance calledadhesinthat locks it firmly into place.
Start of Symptoms
H. pylori stays with you for a lifetime until you clear the infection with antibiotics. Even so, around 80% of people with H. pylori will be entirely asymptomatic and never realize they’ve been infected.
Studies suggest that around 18% of people with H. pylori will experiencegastritis symptoms. The condition tends to bechronic(persistent) with episodic bouts ofacute(sudden, severe) symptoms.
Symptoms of H. pylorigastritisinclude:
Nausea
Peptic Ulcer Disease
Peptic ulcer disease(PUD) is when open sores develop in the stomach lining andduodenum(the first part of thesmall intestine). H. pylori is the most common cause of PUD.
Among people with chronic H. pylori, between 10% and 20% will develop PUD.People with the cagA gene have an 18-fold increased risk of PUD when they have an H. pylori infection.
The symptoms of PUD are similar to chronic gastritis but may also involve:
Gastric Cancer
Gastric (stomach) canceris rare and accounts for less than 2% of all cancers and cancer deaths in the United States.H. pylori is today categorized as a class 1carcinogen(along with things like cigarette smoke and processed meat).
H. pylori is thought to contribute to 89% of these cancers, includinggastricadenocarcinoma(the main form of stomach cancer) and nearly all cases ofgastric MALT lymphoma(a rare type ofnon-Hodgkin lymphoma).
Among people with H. pylori, those who develop stomach ulcers are 3 times more likely to get gastric cancer than those without. By contrast,duodenal ulcers(which develop in the first section of the small intestine) are not associated with gastric cancer. How H. pylori causes gastric cancer is still unknown.
Symptoms of gastric cancer mirror those of PUD but may also include:
What Makes Symptoms Last Longer?
Stress
Psychological stress is known to independently increase the risk of acute gastritis in people with H. pylori. Stress may also contribute to chronic gastritis and the risk of peptic ulcer disease.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Smoking
Alcohol
While alcohol does not increase the risk of H. pylori (in fact, it seems to reduce it),it can damage the lining of the stomach and make gastritis symptoms worse.As with smoking, alcohol overuse can also increase the risk of antibiotic failure in people with H. pylori.
Certain Foods
Foods known to aggravate gastritis in people with H. pylori include:
Do Antibiotics Clear the Infection?
H. pylori can be challenging to treat due to high rates ofantibiotic resistance. The overuse of antibiotics worldwide, particularly among people who are undertreated or fail to complete treatment, has led to the emergence of drug-resistant H. pylori strains.
Experts recommend a 14-day course of optimized bismuth-based quadruple therapy (BQT) for the first-line treatment of adults with H. pylori infection,
The 14-day protocol involves:
The doses should be spaced equally over 24 hours to ensure the drugs remain at a constant therapeutic level in your blood. The medications are typically taken on an empty stomach before meals to improve absorption.
If the first-line treatment fails, other eradication protocols involving antibiotics likeamoxicillin, clarithromycin, and rifabutin will be used.
Secondary Treatment for Severe Infection
Treatment of Ulcers
Severe ulcers may require more invasiveendoscopicprocedures performed undergeneral anesthesiaor withmonitored anesthesia care (MAC). The procedure may involve lasers or electrocautery (uses an electric current) to stop the bleeding with heat or an injection ofepinephrineto shrink local blood vessels.
In people with a history of peptic ulcers, NSAIDs should be avoided and replaced with medications likeTylenol (acetaminophen)that are less likely to promote gastric bleeding.
Periodontal Therapy
Periodontal therapy, involving the removal ofdental plaqueandcalculus (tartar)from your teeth, has been proposed to improve cure rates for H. pylori.
It is well known that dental plaque is a reservoir for H. pylori. Some studies suggest that these reservoirs may resist oral antibiotics and can cause reinfection after treatment is completed.
Probiotics
Healing and Recovery
One study showed that a 14-day course of BQT use for first-line therapy cleared the infection in 97% of cases.
Common side effects include weakness, diarrhea, constipation, loss of appetite, stomach pain, heartburn, ametallic taste in the mouth, a dry or sore mouth, and a dark tongue or stool (due to staining from bismuth).Most side effects are manageable, with only around 2% of users discontinuing treatment due to intolerance.
To better cope with H. pylori treatment and reduce the risk of side effects, here are some things you should do:
Hygiene and Contamination Prevention
As common as H. pylori is, there are a few simple ways to reduce your risk of exposure or prevent the spread of infections to others:
Summary
H. pylori is associated with an increased risk of peptic ulcer disease and gastric cancer. Quadruple therapy involving two antibiotics, one proton pump inhibitor (PPI), and a drug called bismuth can often clear the infection if taken as prescribed.
38 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Shah S, Cappell K, Sedgley R, et al.Diagnosis and treatment patterns among patients with newly diagnosedHelicobacter pyloriinfection in the United States 2016–2019.Sci Rep.2023;13:1375. doi:10.1038/s41598-023-28200-3
University of California San Francisco.Helicobacter pylori infection.
Centers for Disease Control and Prevention.Helicobacter pylori.
Nguyen J, Kotilea K, Bontems P, Meindje Deyi VY.Helicobacter pyloriInfections in children.Antibiotics (Basel).2023;12(9):1440. doi:10.3390/antibiotics12091440
Anand PS, Kamath KP, Anil S.Role of dental plaque, saliva and periodontal disease inHelicobacter pyloriinfection.World J . Gastroenterol. 2014;20(19):5639–5653. doi:10.3748/wjg.v20.i19.5639
Baj J, Forma A, Sitarz M, Portincasa P, et al.Helicobacter pylori virulence factors-mechanisms of bacterial pathogenicity in the gastric microenvironment.Cells. 2020;10(1):27. doi:10.3390/cells10010027
Debowski AW, Walton SM, Chua EG, et al.Helicobacter pylori gene silencing in vivo demonstrates urease is essential for chronic infection.PLoS Pathog. 2017;13(6):e1006464. doi:10.1371/journal.ppat.1006464
Shiota S, Thrift AP, Green L, et al.Clinical manifestations ofHelicobacter pylori–negative gastritis.Clin Gastroenterol Hepatol.2017;15(7):1037-1046.e3. doi:10.1016/j.cgh.2017.01.006
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of gastritis & gastropathy.
Malfertheiner P, Camargo MC, El-Omar E, et al.Helicobacter pyloriinfection.Nat Rev Dis Primer, 2023:9:19: doi:h10.1038/s41572-023-00431-8
Ahmed S, Belahyneh YM.Helicobacter pyloriand duodenal ulcer: systematic review of controversies in causation.Clin Exp Gastroenterol. 2019;12:441–447. doi:10.2147/CEG.S228203
American College of Gastroenterology.Peptic ulcer disease overview.
National Cancer Institute.Cancer fast stats: stomach cancer.
Shin WS, Xie F, Chen B, et al.Exploring the microbiome in gastric cancer: assessing potential implications and contextualizing microorganisms beyondH. pyloriand Epstein-Barr virus.Cancers (Basel).2023;15(20):4993. doi:10.3390/cancers15204993
Paragomi P, Dabo B, Pelucchi C, et al.The association between peptic ulcer disease and gastric cancer: results from the Stomach Cancer Pooling (StoP) Project Consortium.Cancers (Basel).2022 Oct 7;14(19):4905. doi:10.3390/cancers14194905
American Cancer Society.Signs and symptoms of stomach cancer.
Ford AC, Yuan Y, Forman D, Hunt R, Moayyedi P.Helicobacter pylori eradication for the prevention of gastric neoplasia.Cochrane Database Syst Rev. 2020 Jul 6;7(7):CD005583. doi:10.1002/14651858.CD005583.pub3
Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T.Psychological stress increases risk for peptic ylcer, regardless ofHelicobacter pyloriinfection or use of nonsteroidal anti-inflammatory drugs.Clin Gastroenterol Hepatol.2015;13(3):498-506.e3. doi:10.1016/j.cgh.2014.07.052
Budzynski J, Klopocka M.Brain-gut axis in the pathogenesis ofHelicobacter pyloriinfection.World J Gastroenterol.2014;20(18):5212–5225. doi:10.3748/wjg.v20.i18.5212
Sostres C, Gargalio CJ, Lanas A.Interaction betweenHelicobacter pyloriinfection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: old question new insights.World J Gastroenterol.2014;20(28):9439–9450. doi:10.3748/wjg.v20.i28.9439
Salama R, Emara MW, Sharawy.Hazarders of smoking and Helicobacter pylori Infection on gastric mucosa among Egyptian patients with dyspepsia.Open J Gastroenterol.2021;11:1-15. doi:10.4236/OJGAS.2021.111001
Yu J, Yang P, Qin X, Li C, Lv Y, Wang X.Impact of smoking on the eradication of Helicobacter pylori.Helicobacter. 2022;27(1):e12860. doi:10.1111/hel.12860
Du P, Zheng C, Wang A, Ma Z, Shen S, Li X.Association of alcohol drinking and Helicobacter pylori infection: a meta-analysis.J Clin Gastroenterol. 2023;57(3):269-277. doi:10.1097/MCG.0000000000001638
Yu J, Lv Y, Yang P, et al.Alcohol increases treatment failure forHelicobacter pylorieradication in Asian populations.BMC Gastroenterol.2023;23:365. doi:10.1186/s12876-023-03002-z
University of Central Florida Health.H. pylori diet: the best foods to eat and avoid.
Boyanova L, Hadzhiyski P, Gergova R, Markovska R.Evolution ofHelicobacter pyloriresistance to antibiotics: a topic of increasing concern.Antibiotics (Basel).2023;12(2):332. doi:10.3390/antibiotics12020332
American College of Gastroenterology.ACG guideline on treatment ofHelicobacter pylori: new recommendations… will practice change?
Strand DS, Kim D, Peura DA.25 years of proton pump inhibitors: a comprehensive review.Gut Liver. 2017;11(1):27-37. doi:10.5009/gnl15502
National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for peptic ulcers (stomach or duodenal ulcers).
Ren Q, Yan X, Zhou YN, Li WX.Periodontal therapy as adjunctive treatment for gastricHelicobacter pyloriinfection.Cochrane Database Syst Rev.2016;2016(2):CD009477. doi:10.1002/14651858.CD009477.pub2
Zhang Y, Lu B, Dong Y, et al.Saccharomyces boulardiicombined with triple therapy alter the microbiota in the eradication ofHelicobacter pyloriinfection.Sci Rep.2024:14:13152. doi:10.1038/s41598-024-63894-z
Czepiel J, Dróżdż M, Pituch H, et al.Clostridium difficile infection: review.Eur J Clin Microbiol Infect Dis. 2019;38(7):1211-1221. doi:10.1007/s10096-019-03539-6
Yan EH, Chen WY, Chiang HC, et al.10-day versus 14-day bismuth quadruple therapy for first-line eradication ofHelicobacter pyloriinfection: a randomised, open-label, non-inferiority trial.Lancet eClinicalMedicine.2024:70:102529. doi:10.1016/j.eclinm.2024.102529
MedlinePlus.Bismuth, metronidazole, and tetracycline.
Hwang JJ, Lee DH, Lee AR, et al.Fourteen-vsseven-day bismuth-based quadruple therapy for second-lineHelicobacter pylorieradication.World J Gastroenterol. 2015;21(26):8132–8139. doi:10.3748/wjg.v21.i26.8132
Alberta Health Services (Canada).H. pylori bacterial infection: care instructions.
Han YM, Park JM, Jeong M, et al.Dietary, non-microbial intervention to preventHelicobacter pylori-associated gastric diseases.Ann Transl Med.2015;3(9):122. doi:10.3978/j.issn.2305-5839.2015.03.50
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
