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Should I be worried about H. pylori?

H. pylori, also known as Helicobacter pylori, is a type of bacteria that can infect your stomach. It is very common, with around two-thirds of the world’s population carrying the bacteria. Most people infected with H. pylori don’t have symptoms or problems from the infection. However, in some cases, it can lead to ulcers in the stomach and small intestine or stomach cancer. So should you be worried if you have H. pylori? Here is a closer look at the infection and when treatment may be recommended.

What is H. pylori?

H. pylori are spiral-shaped bacteria that can infect your stomach. The bacteria can burrow into the lining of your stomach and live there. H. pylori infection is usually acquired in childhood and often persists throughout life without causing symptoms. However, in some people, the bacteria can cause inflammation and damage in the stomach and small intestine, leading to symptoms.


Most people infected with H. pylori don’t have any symptoms. When symptoms do occur, they can include:

  • Burning or gnawing stomach pain
  • Bloating
  • Nausea
  • Vomiting
  • Loss of appetite
  • Frequent burping
  • Unintentional weight loss

These symptoms can be similar to those caused by ulcers.


In some cases, H. pylori infection can lead to complications such as:

  • Ulcers – H. pylori is the leading cause of peptic ulcers, which are sores in the lining of the stomach or the duodenum (the upper part of the small intestine). The bacteria weaken the protective coating of the stomach and intestine, allowing stomach acid to irritate the sensitive lining beneath.
  • Stomach cancer – Long-term H. pylori infection can increase the risk of stomach cancer. The bacteria causes chronic inflammation in the stomach lining that can lead to cancer over many years.
  • MALT (mucosa-associated lymphoid tissue) lymphoma – This rare type of cancer affects the stomach lining. It occurs as a result of long-term H. pylori infection.

However, it’s important to note that most people colonized with H. pylori never develop any problems or complications from the infection.

How do you get infected with H. pylori?

H. pylori bacteria are usually transmitted from person to person by fecal-oral or oral-oral routes. This can include:

  • Consuming food or water contaminated with feces containing H. pylori
  • Sharing eating utensils or other items contaminated with feces or saliva containing H. pylori
  • Living in crowded or unsanitary conditions that increase exposure risk

Since the bacteria are very common, infection often occurs in childhood when hygiene practices may be suboptimal. In developing countries, 70-90% of the population carries H. pylori. In developed countries, the rate is much lower at around 10-30%. The infection usually persists for life unless treated with antibiotics.

Who is most at risk of H. pylori complications?

Most people infected with H. pylori don’t develop any problems. But some factors can increase your risk of complications:

  • Having a family history of stomach cancer
  • Infection at a young age
  • Presence of certain strains of H. pylori that produce toxins
  • Smoking cigarettes
  • Frequent use of NSAID pain medications like ibuprofen
  • Certain genetic factors
  • Long-lasting infection over many years

So even though H. pylori infection is very common, only around 10-15% of those infected will experience complications. Those at highest risk tend to have one or more of the risk factors above.

How is H. pylori infection diagnosed?

If you have persistent digestive symptoms, your doctor may test you for H. pylori using one or more of the following methods:

Blood test

A blood test checks for antibodies to H. pylori in your bloodstream. If you have an active or previous infection, you will have these antibodies. However, it can remain positive for years after infection, so it cannot distinguish between a current or past infection.

Stool antigen test

A sample of your stool can be tested for proteins unique to H. pylori. This is an accurate way to detect a current infection.

Breath test

For this test, you swallow a substance called urea that has been labeled with carbon atoms. If H. pylori is present, it will release these carbon atoms which are then detected in your breath. This is also an effective way to diagnose current infection.


The most definitive way to diagnose H. pylori is through endoscopy. This involves inserting a long flexible tube with a camera on the end (endoscope) through your mouth and into your stomach. Small samples of tissue can be taken and tested for the bacteria. Endoscopy also allows your doctor to see any damage in your stomach lining.

Test What it detects
Blood test Antibodies to H. pylori
Stool antigen test Proteins from active H. pylori infection
Breath test Carbon released from labeled urea by H. pylori
Endoscopy with biopsy Presence of H. pylori bacteria in stomach lining samples

This table summarizes the different tests available to diagnose H. pylori infection and what each test detects.

How is H. pylori treated?

If you are diagnosed with H. pylori and have symptoms, complications, or high risk factors, treatment will likely be recommended. The standard H. pylori treatment consists of a 1-2 week course of three antibiotics and a proton pump inhibitor or PPI (a medication that reduces stomach acid production).

The antibiotics used most often are clarithromycin, amoxicillin, tetracycline, or metronidazole. PPIs like omeprazole or lansoprazole are given as well. Taking these medications together has been shown to be the most effective way to eradicate H. pylori.

After finishing treatment, your doctor will likely test to confirm the bacteria has been eliminated. If they are still present, you may need another round of antibiotics and PPIs or an alternative regimen. With the proper treatment, H. pylori can be successfully cured in 80-90% of cases.

Treatment Side Effects

Common side effects of H. pylori treatment can include:

  • Nausea
  • Diarrhea
  • Bloating
  • Metallic taste in mouth
  • Headache

These are usually temporary and resolve once treatment is finished. More serious side effects are possible but rare. Be sure to complete the full course of treatment prescribed even if you experience some mild side effects.

What happens if H. pylori is left untreated?

For most people infected with H. pylori, no treatment is required or recommended. However, if you develop persistent digestive symptoms or are at higher risk of complications, leaving it untreated can potentially lead to:

  • Worsening ulcer symptoms and bleeding ulcers
  • Perforated ulcer requiring emergency surgery
  • Increased chance of stomach cancer over time
  • MALT lymphoma of the stomach in rare cases
  • Persistent inflammation in the stomach lining

So while H. pylori often causes no problems at all, it’s important to be aware of potential complications and discuss testing and treatment with your doctor if you have any concerning symptoms or risk factors.

Can H. pylori infection come back?

Unfortunately, it’s possible for H. pylori infection to recur after successful treatment, especially if you are exposed to the bacteria again. This occurs in around 10-35% of cases. Recurrence is more likely if:

  • Other family members are infected
  • You live in crowded conditions
  • Treatment did not fully eliminate the bacteria
  • You have low stomach acid levels

To help prevent recurrence, your doctor will likely recommend testing again at least 4 weeks after you complete treatment. They may also suggest taking a maintenance dose of PPI medication to reduce your chance of becoming re-infected. Practicing good hygiene and sanitation can also help prevent the spread of H. pylori bacteria.

How can I reduce my risk of H. pylori infection?

Here are some tips to help prevent getting infected with H. pylori in the first place:

  • Practice good hygiene – Wash hands thoroughly, especially before eating
  • Avoid food or water that may be contaminated
  • Don’t share eating utensils or drinks
  • Make sure food is cooked thoroughly
  • Drink water from sealed bottles if quality is uncertain
  • Limit alcohol, smoking, and NSAID pain medication use

Because H. pylori spreads through the fecal-oral route, good hygiene and sanitation practices are key to reducing infection risk. While not completely preventable, being mindful of transmission sources can help decrease your chances of acquiring the bacteria.


H. pylori is an extremely common bacterial infection. Most people colonized with H. pylori will never have issues or symptoms from it. However, in a minority of high risk individuals, it can cause digestive problems ranging from ulcers to stomach cancer. If you have persistent digestive symptoms or known risk factors, it is worth getting tested for H. pylori and treating the infection if present. This can prevent complications like ulcers and cancer. With appropriate treatment and follow-up testing, H. pylori can usually be cured successfully. For most healthy individuals though, H. pylori does not require any intervention or cause harm. Overall, the infection does not need to be a major cause of worry for the majority of people. But in select higher risk cases, testing and treatment are appropriate to avoid complications.