Primary Care Society
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
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
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.
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
In other cases where H. pylori has not
caused an ulcer, there may very well
be no improvement.
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
have taken recently would give a
How can H. pylori be treated
and what are the chances
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
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.
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
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.
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