Pylori (H. pylori)
Digestive Health Foundation
An information leaflet for patients and
interested members of the general public
prepared by the Digestive Health Foundation
THIRD EDITION 2010
What is Helicobacter Pylori (H. pylori)?
Its significance for human disease was first recognised in 1983.
The bacterium lives in the lining of the stomach, and the chemicals
it produces causes inflammation of the stomach lining. Infection
appears to be life long unless treated with medications to eradicate
How do I catch H. pylori?
Researchers are not certain how H. pylori is transmitted. It is
most likely acquired in childhood but how this occurs is unknown.
A number of possibilities including sharing food or eating utensils,
contact with contaminated water (such as unclean well water), and
contact with the stool or vomit of an infected person have all been
investigated but the answer is still not known. H. pylori has been
found in the saliva of some infected people, which means infection
could be spread through direct contact with saliva. There is no
evidence that pets or farm animals are sources of infection. Infection
has been shown to occur between family members (e.g. mother
and child) however it is very rare to catch H. pylori as an adult,
most people are infected during childhood.
Can H. pylori infection be prevented?
The overall improvement in standards of domestic hygiene last
century has led to a marked decline in H. pylori in the Western world.
As no one knows exactly how H. pylori spreads, prevention on an
individual level is difficult. Researchers are trying to develop a vaccine
to prevent, and cure, H. pylori infection. To help prevent infection,
doctors advise people to follow good hygiene practices:
• Wash hands with soap and water after using
the bathroom and before eating
• Eat food that has been washed well
and cooked properly
• Drink water from a clean, safe source.
It is the still the most widespread infection in the world.
Actual infection rates vary from country to country.
Infection is more common in developing countries.
In countries with poor sanitation, 90% of the adult
population can be infected.
In Australia infection is now much less common than
in the past particularly in the younger members of the
population. Approximately 40% of Australians over 60
years of age have H. pylori. H. pylori infection is higher
in indigenous communities than in the non-Indigenous
Australian population. H. pylori is also more common
in certain ethnic populations (e.g. Middle Eastern,
Asian and eastern European). There is no difference
in infection rate between men and women.
What diseases does H. pylori cause?
• Inflammation of the lining of the stomach
(gastritis) - frequently
• Duodenal ulcers (in the small bowel just beyond
the stomach) - uncommonly
• Stomach (gastric) ulcers - uncommonly
• Some cancers of the stomach, including a rare
type called lymphoma - rarely
Most people infected with H. pylori never develop
symptoms or disease. Why the bacterium causes
ulcers in some people and not in others is not
known. Most likely, development of ulcers depends
on characteristics of the infected person, the type
or strain of H. pylori present, and factors medical
scientists have yet to discover.
A peptic ulcer is a hole in the gut lining of the stomach
or duodenum. A peptic ulcer of the stomach is called
a gastric ulcer, and in the duodenum it is called a
duodenal ulcer. H. pylori is the most common cause
of peptic ulcers worldwide.
stomach ulcers. Most of the remaining ulcers appear
to be due to certain medications, particularly non-
steroidal anti-inflammatory drugs (NSAIDs) taken
regularly to ease arthritis, or low-dose aspirin to
help prevent heart attack or stroke.
Modern anti-ulcer drugs heal virtually all duodenal
and stomach ulcers but if H. pylori is not eliminated
there is a very high chance that the ulcer will come
back. If H. pylori infection is cured, the risk of the
ulcer returning is very low (unless aspirin or anti-
inflammatory drugs need to be taken). Paracetamol
does not cause ulcers and is a safe alternative for
patients with a previous ulcer.
While H. pylori infection increases the risk of some
cancers of the stomach, cancer of the stomach is
very rare in Australia and only a very small minority
of infected people will ever develop this problem.
Dyspepsia (indigestion) is a word used to describe
pain, discomfort or other symptoms in the upper
abdomen. Most people with dyspepsia do not have
an ulcer, they have “non-ulcer” dyspepsia.It is a
very common problem and is thought to have many
possible causes. Some of these people have H. pylori
infection, but treatment to get rid of the H. pylori does
not always help.
How is H. pylori diagnosed?
Accurate and simple tests for the detection of H. pylori
infection are available:
A breath test shows if you are infected by analysing a
sample of your breath. Breath tests are accurate, safe,
simple and quick to perform. They are a particularly
useful test to check whether the infection has been
successfully treated. Accuracy is reduced if you have
been taking certain medications (e.g. antibiotics in the
previous month and some ulcer-healing drugs in the
previous one to two weeks).
2. Blood Tests
These can detect current or recent infection. They are
not useful for checking whether the infection has been
successfully treated because the antibody to H. pylori
(the marker of the body’s response to infection) remains
in the blood for years.
The infection may be found at the same time as a
peptic ulcer, with a test called endoscopy (also known
as gastroscopy). During endoscopy your doctor passes
a flexible tube into your stomach which allows small
samples to be taken. H. pylori can be detected by a
number of methods – including looking at samples
under a microscope, using a chemical reaction (rapid
urease test) or growing it in the laboratory. Sampling
that misses the H. pylori, or recent use of antibiotics or
drugs that treat ulcers can cause false negative results.
4. Simple Poo Tests
It is also possible to check for H. pylori using a sample
of bowel motion. This method is used to check children.
Everyone with a duodenal ulcer should be tested for
with active ulcers and those who have had a duodenal
ulcer in the past.
2. People with a Stomach Ulcer
Everyone infected with H. pylori who has, or has
previously had, a stomach ulcer should be tested and
treated. This includes people who were taking aspirin
and anti-arthritis drugs when the ulcer developed.
3. People with Non-Ulcer Dyspepsia
Treatment may not cure the dyspepsia. However,
treatment may be considered to reduce the chance
of getting ulcers (or possibly stomach cancer) in
The side-effects and cost of treatment need to be
weighed against the possible benefits. For instance,
possible side effects might outweigh possible benefits
in an elderly, fit person with no symptoms.
How should H. pylori be treated?
Not everyone infected with H. pylori should be treated.
Most infected people have no symptoms and therefore
do not require treatment.
Those people who do have an ulcer present or have had
a past history of ulcers should have
H. pylori eliminated. This is because successful treatment
will speed ulcer healing and prevent ulcers recurring. A
minority of people with ulcerlike symptoms but no ulcer
(non-ulcer dyspepsia) may also improve if H. pylori is
Unfortunately there is no single drug that is effective
against H. pylori. Treatment combinations include at least
three drugs (triple therapy). The use of drug
combinations reduces the risk of
H. pylori becoming resistant to treatment.
There are a number of drug combinations used at the
present time to treat H. pylori. The most effective of these
are successful in 80-90% of people. The success rate is
much lower if the drugs are not taken exactly as directed.
The drug combinations most commonly used include
an ulcer healing drug (e.g. Omeprazole, Lansoprazole,
Pantoprazole, Bismuth or Ranitidine-Bismuth-Citrate),
and two antibiotics (e.g. Amoxycillin, Clarithromycin,
Metronidazole, Tinidazole or Tetracycline). Several
combination packs containing all the drugs needed
for a course of treatment are now available in
Australia. Treatment is usually for seven days.
Side effects can occur from each of these medications,
or from interactions with other medications, and
may include nausea, taste disturbances, diarrhoea
or skin rashes. Some people taking Metronidazole
or Tinidazole have an unpleasant reaction to alcohol
while they are taking these antibiotics and for this
reason people are advised not to drink alcohol while
taking these medications. Very rarely more serious
side effects may occur, such as bacterial infection of
the large bowel (pseudomembranous enterocolitis) or
a sudden drop in blood pressure (anaphylaxis). Before
you start treatment it is important to tell your doctor if
you have ever had any side effects to antibiotics.
An antacid may make the ulcer pain go away
temporarily, but it will not kill H. pylori. People being
treated for an H. pylori ulcer should check with their
doctor before taking antacids. Some of the antibiotics
used to kill H. pylori may not work as well if combined
with an antacid.
Food and special diets are now known to have very
little impact on the prevention or treatment of ulcers.
Ulcers are not caused by stress or eating spicy food
nor are ulcers healed by drinking milk. Smoking and
drinking alcohol worsen ulcers and prevent healing.
How do I know if the treatment
If you take the treatment exactly as directed, the
chance of successful treatment is high. It is not always
necessary to check that H. pylori has been eliminated
(although many people wish to know).
H. pylori eradication should be checked before
stopping anti-ulcer drugs especially if you have had
a serious ulcer complication such as bleeding or
perforation (a hole in the lining of the stomach or small
bowel), or if your ulcer has often recurred. If you have
to have another endoscopy, it is very simple to look for
important that these tests are performed at least four
weeks after all treatment is stopped, as H. pylori can
grow again within this time.
If the treatment has not been successful, a different
combination of drugs may be tried.
Digestive Health Foundation
This information leafl et has been designed by the Digestive Health
Foundation as an aid to people who have been infected with
Helicobacter Pylori (H. pylori), or for those who wish to know more
about this topic. This is not meant to replace personal advice from
your medical practitioner.
The Digestive Health Foundation (DHF) is an educational body
committed to promoting better health for all Australians by
promoting education and community health programs related to the
The DHF is the educational arm of the Gastroenterological Society of
Australia (GESA). GESA is the professional body representing the
specialty of gastrointestinal and liver disease. Members of the Society
are drawn from physicians, surgeons, scientists and other medical
specialties with an interest in gastrointestinal (GI)disorders.
GI disorders are the most common health related problems affecting
Research and education into gastrointestinal disease are essential to
contain the effects of these disorders on all Australians.
For further information on a wide variety of gastrointestinal conditions
is available on our website.
® Copyright: Digestive Health Foundation, August 2010
This leaflet is promoted as a public service by the Digestive Health Foundation.
It cannot be comprehensive and is intended as a guide only. The information
given here is current at the time of printing but may change in the future.
If you have further questions you should raise them with your own doctor.
Am I likely to become infected again?
No. Once you have had successful eradication of
H. pylori, the risk of being reinfected is very low
(only about 0.5-1.0% per year). This is because
most infection is acquired in childhood.
Are there benefits from being
infected with H. pylori?
There is increasing evidence to make scientists
believe there may be benefits from being infected
with H. pylori. For this reason infection is only treated
when the risks of infection outweigh the possible
benefits as in the case of ulcer disease.
Do my family members need to be
tested if I am infected?
This is not usually recommended. Occasionally there
are special circumstances and this can be discussed
with your doctor.