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Helicobacter pylori?


How can H. pylori be treated?

Might H. pylori even be good for us? 

What research is needed? 

What problems can H. pylori cause?

Does H. pylori cause cancer? 

What is Helicobacter pylori?

How do doctors test for H. pylori

In association with:

Primary Care Society  

for Gastroenterology



  In nearly nine out of ten people  

who have H. pylori, it does not cause 

any problems. 

How do people get it and can 

they pass it on? 

 People who do have H. pylori almost

always catch it in childhood, probably

from other children or family

members. Once someone picks up

H. pylori, it stays in the stomach

throughout life unless it is treated

with particular antibiotics. H. pylori is

actually becoming less common and

nowadays it is unusual for children to

catch it, even if someone else in the

family has it. People living in the UK

today who have H. pylori are unlikely

to pass it on and do not need to take

any special measures to avoid giving

it to others.

What problems can  

H. pylori cause? 

 About 15% of people with H. pylori

infection get ulcers either in the

stomach (gastric ulcer) or in the

duodenum (duodenal ulcer).

Although ulcers tend to cause

indigestion, occasionally they

become much more serious as they

can bleed or even burst (perforate)

which happens if the ulcer burrows

deep enough actually to make a hole.

People with ulcers should therefore

be treated with the aim of getting rid

of H. pylori.

 Bad indigestion is common and there

are many other reasons why people

get this symptom other than having

ulcers. Because there are millions of

people who have both H. pylori and

indigestion, it can be tempting to

draw the conclusion that one leads to

the other. This is simply not the case

in the vast majority of people.

Does H. pylori cause cancer? 

 It is true to say that H. pylori is

associated with a very slightly

increased risk of stomach cancer.

However, treating H. pylori simply

to reduce this risk is not generally

advised for three reasons. Firstly, the

risk of any of us getting stomach

cancer is small. Secondly, no-one

knows whether treating H. pylori

once you are an adult will actually

reduce the risk of developing

stomach cancer at all. Thirdly,

although treatment is usually

very straightforward, a course of

antibiotics does carry a small risk of a

bad reaction and indeed the problems

that the treatment may cause can

outweigh any possible benefit.

Does treating H. pylori make 

you better? 

  If you have an ulcer 

 Before we knew about H. pylori,

ulcers did heal up with acid-reducing

drugs only to come back when the

treatment was stopped. Treating

H. pylori not only helps ulcers to

heal but, more importantly, it greatly

reduces the risk of the ulcer coming

back in the future. Although H. pylori

is the cause of most ulcers, there are

some which are caused by aspirin and

similar drugs used to treat joint and

muscle problems. Nevertheless, all

doctors are agreed that patients with

H. pylori should have treatment for

the infection if they have, or ever have

had, an ulcer.

  If you don’t have an ulcer 

 Less than one person in 10 with

the combination of indigestion and

H. pylori infection, but who don’t have

an ulcer, will feel better as a result

of treatment. Many doctors consider

the disadvantages of taking a course

of antibiotics are just not worth

the small chance of the treatment

helping. It is fair to say that there

are doctors who would recommend

What is Helicobacter pylori?

Helicobacter pylori (H. pylori) is a bacterium,

a kind of germ, which lives in the sticky

mucus that lines the stomach. About 40%

of people in the UK have H. pylori in their

stomach so it is very common.


MIgHT H. pylori eveN 



experts think that H. pylori

like other bacteria living in 

our gut, may be good for 

us. However, no-one has yet 

found a definite advantage 

from having it although a 

number of theories have been 

put forward. 





treating H. pylori even without an

ulcer being present. They do this in

the hope of making a small number

of such people feel better.

  If you have indigestion but neither 

you nor your doctor know if you 

have an ulcer 

 Until recently most people with bad

indigestion often had an endoscopy

(an examination of the stomach

with a small tube and camera) to see

whether or not an ulcer was present.

Nowadays, people with indigestion

who also have worrying symptoms

such as weight loss, persistent

vomiting or trouble in swallowing

still need to have an endoscopy.

Otherwise, most patients are treated

without the need to have that

examination. Instead, many doctors

test their patients with indigestion

to see if they have H. pylori and, if

the test is positive, they treat the

infection. However, without an

endoscopy, the doctor just cannot

know whether or not an ulcer is

present. If the patient has actually

had an ulcer, we know that treating

H. pylori is likely to prove successful.

In other cases where H. pylori has not

caused an ulcer, there may very well

be no improvement.


H. pylori - greatly magnified

How do doctors test for  

H. pylori

 The easiest way is a blood test. This

is useful for finding out whether a

person has H. pylori but the test stays

positive even after the H. pylori has

gone. This means that it cannot tell

us whether a course of treatment has

cleared the infection.

 Another simple technique of looking

for H. pylori involves a breath test.

For this you will be given a drink

containing a substance called urea.

Whether or not H. pylori is present

in the stomach can be detected by

collecting a sample of your breath for

a short time after taking the drink.

This test is used to find out whether

treatment has been successful

although it needs to be done at

least one month after the course of

treatment has finished. Stool antigen

tests for H. pylori are now widely

used. These involve analyzing a small

portion of stool for H. pylori antigens.

 Doctors can also test for H. pylori while

patients are having an endoscopy. A

very small piece of the lining of the

stomach (a biopsy) is sent to the

laboratory for a number of different

tests to check whether or not H. pylori

is present in the stomach.

 All tests for H. pylori except the blood

test may be quite inaccurate if people

have had a recent course of antibiotics

for any reason or have taken some

of the other drugs which are used to

treat ulcers. Your doctor will certainly

ensure that you do not have a test for

H. pylori if other medicines you might

have taken recently would give a

misleading result.

How can H. pylori be treated 

and what are the chances  

of success? 

 Treatment for H. pylori is now simple

and successful at the first attempt in

most people. It consists of a one week

course of three different tablets, two

of which are antibiotics and the third

is a tablet to cut down the amount

of acid in your stomach. These are

all taken together twice a day. Your

doctor will ask you whether you are

allergic to any particular antibiotics

before treatment is started.

 Most people experience no side-

effects from treatment, but a few

notice minor problems such as a

strange taste in the mouth, a feeling

of sickness, diarrhoea or perhaps

a headache. With one particular

antibiotic that is often used, you

should avoid alcohol. Treatment is

much more successful if the whole

course of tablets is taken exactly

as prescribed and your doctor will

encourage you to continue to take

the tablets unless the side-effects

become unpleasant. Even when

treatment has been successful in

clearing the H. pylori, sometimes

symptoms take a little while to settle

down. If the treatment is shown to be

unsuccessful in clearing H. pylori, it

is possible to have further courses of

therapy with different antibiotics.

Do doctors generally 

agree on when to treat 

Helicobacter pylori? 

 All doctors will advise treatment if you

have (or have had) an ulcer. Opinion

is divided on whether to treat the

infection in other situations. Indeed

some doctors advise that it is best to

treat every patient who has a positive

test for Helicobacter pylori. It is best

to discuss with your doctor whether

treatment is likely to be right for you.

What research is needed on 

H. pylori

 H. pylori was only discovered in

1983. Although we have learned an

enormous amount about it, there is

still much we do not know. For example,

it’s not clear exactly how H. pylori is

passed from one person to another,

and why only some people with the

infection get ulcers. We do not know

how H. pylori increases the risk of

stomach cancer. A better understanding

of this may help us to work out how

this cancer arises and might just tell

us more about cancer formation more

generally. Treatment for H. pylori is

now very effective but it can become

resistant to common antibiotics and

we need to develop strategies to stop

this happening as well as finding

alternative treatments for cases

when resistance develops. We also

need to develop a vaccine to prevent

H. pylori infection in countries where

it is common and associated with

gastric cancer. H. pylori is gradually

becoming less common in the UK, but

research is urgently needed on what

to do about it in the developing world

where it is still very common indeed.


May 2009



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