Helicobacter Pylori Infection

What is H. pylori infection and who does it affect?

Helicobacter pylori (commonly just called H. pylori) is a bacterium (germ). It can infect the lining of the stomach and duodenum. It is one of the most common infections in the UK. More than a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life.

What problems does H. pylori cause?

Usually none
Most people with H. pylori have no symptoms and do not know that they are infected.

Stomach and duodenal ulcers
H. pylori is the most common cause of duodenal and stomach ulcers. About 3 in 20 people who are infected with H. pylori develop an ulcer. An ulcer is where the lining of the stomach or duodenum is damaged by the acid which is made in the stomach, and the underlying tissue is exposed. If you could see inside your guts, an ulcer looks like a small, red crater on the lining of the stomach or duodenum.

The exact way H. pylori causes ulcers in some infected people is not clear. In some people it seems to alter the protective layer of mucus that lines the stomach and duodenum. This may allow acid to 'burn' the cells to cause inflammation and ulcers.

Functional dyspepsia
This is a condition where you have recurrent bouts of indigestion (dyspepsia) which are not caused by an ulcer or inflammation. It is sometimes called non-ulcer dyspepsia. H. pylori is sometimes found in people with functional dyspepsia. Getting rid of H. pylori cures some cases, but makes no difference in most cases. The cause of most cases of functional dyspepsia is not known.

Cancer
The risk of developing stomach cancer is thought to be increased with long-term infection with H. pylori. However, it has to be stressed that more than a quarter of people in the UK become infected with this bacterium, and the vast majority to not get stomach cancer. The increased risk is very small. Your risk may be greater if you have H. pylori in addition to having a first degree relative (mother, father, brother, sister or child) who has been diagnosed with stomach cancer.

How is H. pylori diagnosed?

• A 'breath test' can confirm that you have a current H. pylori infection. (A sample of your breath is analysed after you take a special drink.)
• An alternative test is the 'stool antigen test'. In this test you give a pea-sized sample of your faeces (stools) which is tested for H. Pylori.
• A blood test can detect antibodies to H. pylori. This is sometimes used to confirm that you are, or have been, infected with H. pylori. However, it takes six months or more for this test to become negative once the infection has cleared. So, it is not much use to confirm whether treatment has cleared the infection (if this needs to be known). If needed, the breath test or stool antigen test are usually used to check if an infection has cleared following treatment.
• Sometimes a biopsy (small sample) of the lining of the stomach is taken if you have a gastroscopy (endoscopy). The sample can be tested for H. pylori.

How is H. pylori cleared from the stomach and duodenum?

H. pylori is killed by certain antibiotics. However, a combination of medicines is needed to completely get rid of it. You need to take two antibiotics at the same time. In addition, you need to take a medicine to reduce the acid in the stomach. This allows the antibiotics to work well in the stomach. You need to take this 'combination therapy' for a week. It is important to take all the medicines exactly as directed, and to take the full course.

Combination therapy clears H. pylori in up to 9 in 10 cases if it is taken correctly for the full course. If you do not take the full course then the chance of clearing the infection is reduced. A second course of combination therapy, using different antibiotics, will usually work if the first course does not clear the infection.

Combination therapy is sometimes called 'triple therapy' as it involves three medicines - two antibiotics and and acid suppressing medicine.

Who should be tested for H.Pylori, and treated if it is found?

If you have recurring 'dyspepsia' (recurring indigestion symptoms)
If you have recurring dyspepsia, it is common practice to test for H. pylori before doing any other tests. If H. pylori is found, then combination treatment is often given. The exact diagnosis may not be known. (For example, it might not be clear if the dyspepsia is caused by a duodenal or stomach ulcer, or functional dyspepsia, or gastritis, etc. These can only be confirmed by having a 'look down' into the gut with a test called gastroscopy.) However, if symptoms go after treating for H. pylori, then that is the end of the matter. You do not need further tests such as gastroscopy. You will not know exactly what caused the symptoms, but it does not matter if symptoms go as whatever was causing the symptoms will have gone!

Other reasons for testing
If you are in one of the following groups, you may be offered a test for H. pylori and offered treatment with combination therapy if it is found. If you:

• have a duodenal or stomach ulcer. Combination therapy will usually cure the ulcer.
• have functional dyspepsia. Combination therapy may work and clear symptoms, but it does not in most cases.
• have a first degree relative (mother, father, brother, sister or child) who has been diagnosed with stomach cancer. Treatment is advised even if you do not have any symptoms. The aim is to reduce your future risk of stomach cancer.
• are taking long-term anti-inflammatory medicines such as ibuprofen, diclofenac, aspirin, etc. The combination of these medicines and H. pylori increases the risk of developing a stomach ulcer.
• have a MALToma (mucosa-associated lymphoid tissue lymphoma).
• have atrophic gastritis.
• have had an operation to remove a stomach cancer.

Are there any side-effects of combination therapy?

Up to 3 in 10 people develop some side-effects when they take combination therapy. These include: indigestion, feeling sick, diarrhoea, and headaches. However, it is worth persevering for the full course if side-effects are not too bad. A switch to a different set of medicines may be advised if the first combination does not clear the H. pylori, or if it causes bad side-effects.

© EMIS and PIP 2005   Updated: June 2005   PRODIGY Validated