H. pylori, a true stomach “bug”: Who should doctors test and treat?

Wynne Armand, MD

Contributing Editor

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In 1982, two Australian scientists discovered that a certain bacterium, Helicobacter pylori, was a common cause of persistent stomach inflammation and stomach ulcers. This realization revolutionized ulcer treatment.

While fairly common, this infection usually causes no symptoms, but it can sometimes lead to ulcers in the stomach or the very first part of the small intestine (duodenum), and to certain types of stomach cancer. There is also evidence linking H. pylori infection to other conditions like iron-deficiency anemia and vitamin B12 deficiency. The bacteria are thought to spread through contaminated water, vomit, or feces. Most infections are acquired in childhood and often within families, especially in developing countries.

Should everyone be tested for H. pylori?

No, not everyone. You should be tested if you have ongoing dyspepsia (discomfort or pain in the upper abdomen) or if you have an associated condition like peptic ulcers or stomach cancer. Testing for H. pylori is not needed for typical symptoms of acid reflux (heartburn).

In a recent guideline update, the American College of Gastroenterology also suggests H. pylori testing if you are on long-term aspirin therapy or starting long-term NSAID therapy (e.g., ibuprofen, naproxen) to help reduce the risk of developing ulcers and gastrointestinal bleeding. A Chinese study showed that patients with a history of bleeding ulcers and H. pylori infection who were also on low-dose aspirin were less likely to experience a recurrence of stomach bleeding when the infection was treated. Studies on patients taking NSAIDs have had mixed results. An analysis of the combined results of several of these studies showed that treating H. pylori infection reduced the number of ulcers in patients starting NSAID therapy, but not for patients already taking these medications. It’s important to keep in mind that these studies don’t provide the most definitive data. We don’t know that testing everyone taking aspirin or NSAIDs long-term is cost-effective, so it’s best to talk with your doctor. Together you can determine your personal risk of ulcer bleeding against the cost and inconvenience of testing and risks of taking antibiotics.

Testing for H. pylori

The H. pylori infection can be detected by submitting a stool sample (stool antigen test) or by using a device to measure breath samples after swallowing a urea pill (urea breath test). For both of these tests to be reliable, it is important to stop taking acid-reducing medications called proton pump inhibitors (like Prilosec, Nexium, Protonix) for two weeks, and to avoid any bismuth products (like Pepto-Bismol) or antibiotics for four weeks before the test. Blood tests (serology or antibody test) are no longer recommended for most people because there are more false positives (abnormal test result when you may not have the infection), and this blood test can’t help tell whether you’ve had the infection in the past or have a current active infection. If you have specific risk factors for stomach cancer, your doctor may recommend starting with an upper endoscopy. For this test, a flexible tube with a camera is passed through the mouth and into the digestive tract. During an endoscopy the doctor can take tissue samples (biopsies) if necessary, as well as do H. pylori testing.

Treating H. pylori

Treatment for H. pylori infection is challenging. It usually involves taking a combination of three or four medications multiple times a day for 14 days. And rising antibiotic resistance has made it increasingly difficult to cure the infection. The treatment is roughly 80% effective in getting rid of the infection, but the cure rate depends on picking the right combination of medications, taking them correctly, and finishing the full course of treatment. Your doctor will factor in what the antibiotic resistance pattern is like in your region, as well as any drug allergies you might have and other medications you take, to avoid a drug interaction. Another important consideration is what antibiotics you have taken in the past for other infections. It is best to avoid ones you have already used often, as it is more likely the H. pylori will be resistant to these.

Most experts recommend testing four or more weeks after treatment ends to confirm the infection is cured. If it isn’t, this means trying another therapy with a different combination of antibiotics. After one or more treatment failures, it may be time to have an endoscopy to obtain a culture and identify exactly which antibiotics will kill the bacteria.

If you have a condition associated with H. pylori infection or are at risk for stomach ulcers, talk to your doctor about whether testing is right for you. Testing correctly is important to reliably diagnose the infection and avoid unnecessary treatment.

Related Information: The Sensitive Gut


  1. Mike

    I’ve been suffering for 1 year now my doctor said I had twisted stomach so I went had operation and still the same and when I ask my doctor we’re is imagining of my stomach twisted he avoided question let’s me believe I never had a twisted stomach I’ve allways came back positive for hpylori and I’ve just tested positive again I need help my life is ruined thay put me true test but wont listen to me

  2. Paul Richard

    How is H.Pylori infection treated naturally?

  3. Anup

    Thank you for the wonderful article. Was very informative…

    I recently experienced burning sensation in my stomach and some acid reflux and was diagnosed with h pylori . The doctor diagnosed this through a nasal endoscopy. No ulcers were found. The doctor then suggested me to take an h pylori kit for a week. However when I discussed this with a family doctor back home, he suggested that as my motions were regular and as I had no vomiting sensations and no other major difficulties there was no need to take the h pylori kit. I have very mild burning sensations that come occasionally during the day which increases when I take cola, or lots of tea. I also have slight acid reflux in the night..Should I take the hpylori kit in your opinion

    • Wynne Armand

      If your physician thinks that your symptoms might be related to an active H. pylori infection, it makes sense to treat it.
      Many physicians recommend treatment of an active H. pylori infection even if there are no associated symptoms, though there is no clear consensus on this.
      Wynne Armand

  4. martin

    This is big issue, 50% population of the world have it, and some people like me develop numerous symptoms. WHO classified this bacteria as one of the resistant bacteria in the world. My doctor keep give me 6 rounds of antibiotics ( 2 weeks for 1 rounds) 3 month of treatment with clarithromycin , ppi, pepto bismol, but the blood test result keep telling it positive. And my doctor won’t the change the treatment. So i use mastic gum now, but no new research about mastic gum killing H plori, the latest research on internet is 1998. I hope a lot of scientist can do more research on this.

    Because this H Plori has taken my daily life. Before i found this bacteria in my body, all the doctor just give me ppi, pepto bismol, antidepressan, telling me not so stress, it’s just in my mind bla..bla…bla… Nothing is work. it’s been 5 years. Now i found glittering of hope maybe if eradicated this H plori my stomach problem will be gone.

    • Wynne Armand

      Thank you for sharing your story. Perhaps you could discuss with your doctor having one of the other tests to diagnose H. pylori, if available to you (stool antigen test, urea breath test) since the antibody blood test can sometimes stay high/abnormal even after the bacteria is cleared. You would need to stop the PPI for 2 weeks prior to these other tests. It also may be of value to you to have an endoscopy with biopsy and culture to determine which antibiotics the bacteria is sensitive and resistant to, which would help guide your treatment.
      Best wishes to you.

    • Galina Gorelik

      Too many doctors are pushing the awful antibiotics without ever considering natural alternatives (big surprise!). I recommend Siberian Pine Nut Oil to all people who have been told that H. Pylori is the reason for their ulcer and who were urged to take poisonous antibiotics to combat it. I knew I was NEVER going to take the antibiotics, despite emergency surgery for a perforated duodenal ulcer I didn’t know I had, especially after reading what people endure taking them. The antibiotics may not even work the first time, and it’s not even clear if H. Pylori is the sole cause of the ulcer (as most people have H. Pylori and don’t have ulcers). So I looked for a natural alternative and found this oil. I took the oral test for H. Pylori within a couple of months of taking the oil (I make my own capsules with it and take 4 three times a day on an empty stomach), and the breath test was negative. Now, after about six months taking it, I had an endoscopy and a biopsy specifically for H. Pylori, which definitively showed that I was NEGATIVE for it. My doctor was amazed. Reading all the reviews of people who have various gastric issues helped by this oil just convinces me all the more that it’s doing great things even if I’m not symptomatic for all the other complaints people describe. So I would say to anyone reading this, please try this oil before you consider going the Big Pharma route, which is never a good idea, in my opinion.

  5. dee

    If you have mysterious symptoms that lead you know where, get tested for Celiac disease and HP at the same time.
    Don’t take antacids or depression pills unless you get tested for both CD and HP and other autoimmune diseases first.
    Many mental illnesses such as depression and anxiety can be caused by autoimmune diseases such as CD. But they almost never test for it, unless you pressure the docs. I want to see this changed, CD is a terrible disease and the HP compounds the pain. To say HP is not an issue, please tell me, why are so many folks taking antacids? If we cured HP in each person, big pharm would loose a lot of millions, maybe billions of dollars. It is never about health and wellness it is all about that good old bottom dollar.
    I am troubled that the link between HP and CD was not even mentioned in this article.

  6. Vivian Arce

    If you took medicine for H Pylori and your fine can you still get cancer.

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