H. pylori infection

Gastrointestinal symptoms like abdominal pain, dyspepsia, bloating, fatigue, and anaemia can indicate inflammation in the stomach, known as gastritis. When severe, this can lead to ulcers, both stomach ulcers and duodenal ulcers, which can cause significant pain, bleeding, and in some cases emergencies requiring surgery. We now know that many cases like this are due to an infection in the stomach, known as H. pylori.

Until the 1980s, scientists thought that acid in the stomach kept the contents sterile, and that bacteria could not live in the stomach lining. That all changed when two Australian scientists discovered a particular bacteria, Helicobacter pylori, could not only survive in the stomach, but could stay there for many years, leading to inflammation and ulcers. This ground-breaking discovery would win them the Nobel Prize, and lead to important developments in gastroenterology treatments.

H. pylori infections are common, affecting billions of people worldwide, and around 25% of the UK population have been infected at some point. Most people with an H pylori infection do not have symptoms, but many will develop gastrointestinal symptoms, stomach inflammation (gastritis), or stomach ulcers. Long-term (chronic) H. pylori infection can also increase the risk of stomach cancer. For this reason, we often test for H. pylori infection, and eradicate the infection with antibiotics if positive.

The infection can be tricky to test for, as medications such as proton pump inhibitors (PPIs, such as Omeprazole) and antibiotics in the weeks before a test can lead to false negative tests. Testing may involve testing stool samples (H. pylori antigen testing), breath tests, antibody tests, or specialist tests performed at the time of endoscopy or gastroscopy. If we discover an H. pylori infection, we will eradicate the infection with a course of two different antibiotics plus anti-acid medications.

While such treatments are generally effective, in about 15% of people the first line antibiotics won’t get rid of the infection. Therefore in many cases it is important to confirm that the infection has been successfully treated with repeat testing. For recurrent infections, longer courses of specialist antibiotics are needed, sometimes guided by culture and sensitivity testing of the bacteria. This can sometimes be a frustrating process, but it is important to ensure the infection is successfully treated in order to reduce the risk of recurrent symptoms, ongoing inflammation, and minimise the risk of complications like cancer.

To see Michael FitzPatrick about the diagnosis or management of H. pylori infection, click the button below to arrange a consultation today.