Digestive Health Foundation

Helicobacter 

Pylori (H. pylori)

Information about

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)?

H. pylori is a bacterium (germ) that can infect the human stomach.  

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  

the bacterium.

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.

How common is H. pylori infection?

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? 

H. pylori can 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.

Peptic ulcers

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.

1. Stomach ulcers

H. pylori is the cause of approximately 70% of  

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.

2. Duodenal ulcers

H. pylori is the cause of about 90% of ulcers in  

the duodenum.

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.

Cancer of the stomach

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.

Non-ulcer Dyspepsia

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:

1. Breath Tests

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.

3. Endoscopy

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.

Who should be tested for H. pylori?

1. People with a Duodenal Ulcer

Everyone with a duodenal ulcer should be tested for  

H. pylori  and treated if infected. This includes people 

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 future.

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 

eradicated.

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  

has worked?

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 

H. pylori using one of the tests described above. It is 

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

c/- GESA

PO Box 508, Mulgrave VIC 3170, Australia

Telephone: [phone]  Facsimile: [phone]

www.gesa.org.au

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 

digestive system.

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 

the community.

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.

Further questions

If you have further questions, consult with your doctor.