Helicobacter pylori(H. pylori) is a type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.
Infection with H. pylori is common. About two-thirds of the world’s population has it in their bodies. For most people, it doesn’t cause ulcers or any other symptoms. If you do have problems, there are medicines that can kill the germs and help sores heal.
As more of the world gets access to clean water and sanitation, fewer people than before are getting the bacteria. With good health habits, you can protect yourself and your children from H. pylori.
How H. pylori Makes You Sick
For decades, doctors thought people got ulcers from stress, spicy foods, smoking, or other lifestyle habits. But when scientists discovered H. pylori in 1982, they found that the germs were the cause of most stomach ulcers.
After H. pylori enters your body, it attacks the lining of your stomach, which usually protects you from the acid your body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.
You can get H. pylori from food, water, or utensils. It’s more common in countries or communities that lack clean water or good sewage systems. You can also pick up the bacteria through contact with the saliva or other body fluids of infected people.
Many people get H. pylori during childhood, but adults can get it, too. The germs live in the body for years before symptoms start, but most people who have it will never get ulcers. Doctors aren’t sure why only some people get ulcers after an infection.
If you have an ulcer, you may feel a dull or burning pain in your belly. It may come and go, but you’ll probably feel it most when your stomach is empty, such as between meals or in the middle of the night. It can last for a few minutes or for hours. You may feel better after you eat, drink milk, or take an antacid.
Other signs of an ulcer include:
Ulcers can bleed into your stomach or intestines, which can be dangerous to your health. Get medical help right away if you have any of these symptoms:
- Stool that is bloody, dark red, or black
- Trouble breathing
- Dizziness or fainting
- Feeling very tired for no reason
- Pale skin color
- Vomit that has blood or looks like coffee grounds
- Severe, sharp stomach pain
It’s not common, but H. pylori infection can cause stomach cancer. The disease has few symptoms at first, such as heartburn. Over time, you may notice:
Getting a Diagnosis
If you don’t have symptoms of an ulcer, your doctor probably won’t test you for H. pylori. But if you have them now or have in the past, it’s best to get tested. Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage your stomach lining, so it’s important to find out what’s causing your symptoms so you can get the right treatment.
To start, your doctor will ask you about your medical history, your symptoms, and any medicines you take. Then they’ll give you a physical exam, including pressing on your belly to check for swelling, tenderness, or pain. You may also have:
- Tests of your blood and stool, which can help find an infection
- Urea breath test. You’ll drink a special liquid that has a substance called urea. Then you’ll breathe into a bag, which your doctor will send to a lab for testing. If you have H. pylori, the bacteria will change the urea in your body into carbon dioxide, and lab tests will show that your breath has higher than normal levels of the gas.
To look more closely at your ulcers, your doctor may use:
- Upper gastrointestinal endoscopy. In a hospital, a doctor will use a tube with a small camera, called an endoscope, to look down your throat and into your stomach and the upper part of your small intestine. The procedure may also be used to collect a sample that will be examined for the presence of the bacteria. You may be asleep or awake during the procedure, but you’ll get medicine to make you more comfortable.
- Upper GI tests. In a hospital, you’ll drink a liquid that has a substance called barium, and your doctor will give you an X-ray. The fluid coats your throat and stomach and makes them stand out clearly on the image.
- Computed tomography (CT) scan. It’s a powerful X-ray that makes detailed pictures of the inside of your body.
If you have H. pylori, your doctor may also test you for stomach cancer. This includes:
- Physical exam
- Blood tests to check for anemia, when your body doesn’t have enough red blood cells. It could happen if you have a tumor that bleeds.
- Fecal occult blood test, which checks your stool for blood that’s not visible to the naked eye
- Biopsy, when a doctor takes a small piece of tissue from your stomach to look for signs of cancer. Your doctor may do this during an endoscopy.
- Tests that make detailed pictures of the insides of your body, such as a CT scan or magnetic resonance imaging (MRI)
Treatment for H. pylori
If you have ulcers caused by H. pylori, you’ll need treatment to kill the germs, heal your stomach lining, and keep the sores from coming back. It usually takes 1 to 2 weeks of treatment to get better.
Your doctor will probably tell you to take a few different types of drugs. The options include:
- Antibiotics to kill the bacteria in your body, such as amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl), tetracycline (Sumycin), or tinidazole (Tindamax). You’ll most likely take at least two from this group.
- Drugs that reduce the amount of acid in your stomach by blocking the tiny pumps that produce it. They include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), or vonoprazan/amoxicillin/clarithromycin (Voquezna).
- Bismuth subsalicylate, which may also help kill H. pylori along with your antibiotics
- Medicines that block the chemical histamine, which prompts your stomach to make more acid. These are cimetidine (Tagamet), famotidine Pepcid, Zantac 360), and nizatidine (Axid).
Your treatment could mean you’ll take 14 or more pills per day for a few weeks, which seems like a lot of medicine. But it’s really important to take everything that your doctor prescribes and to follow their instructions. If you don’t take antibiotics the right way, bacteria in your body can become resistant to them, which makes infections harder to treat. If your medications bother you, talk to your doctor about your treatment options and how you can handle side effects.
About 1-2 weeks after you finish your treatment, your doctor may test your breath or stool again to make sure the infection is gone.
You can protect yourself from getting an H. pylori infection with the same steps you take to keep other germs at bay:
- Wash your hands after you use the bathroom and before you prepare or eat food. Teach your children to do the same.
- Avoid food or water that’s not clean.
- Don’t eat anything that isn’t cooked thoroughly.
- Avoid food served by people who haven’t washed their hands.
Though stress and spicy foods don’t cause ulcers, they can keep them from healing quickly or make your pain worse. Talk to your doctor about ways to manage your stress, improve your diet, and, if you smoke, how you can get help to quit.
What can I expect after H. pylori infection?
Most ulcers caused by H. pylori will heal after a few weeks of treatment. If you’ve had one, you should avoid taking NSAIDs for pain, since these drugs can damage your stomach lining. If you need pain medicine, ask your doctor to recommend some.
Where can I find information or support?
You can find information about H. pylori infection and ulcers from the American College of Gastroenterology. For information on stomach cancer, as well as online and local support groups, visit the American Cancer Society.