Helicobacter pylori (H. pylori) infection is a bacterial infection that causes stomach inflammation (gastritis), peptic ulcer disease, and certain types of stomach cancer.
The infection is caused by a type of bacteria called Helicobacter pylori (H. pylori).
When symptoms of H. pylori infection do occur, they include indigestion and pain or discomfort in the upper abdomen.
Doctors often base the diagnosis on the results of a breath or stool test or on an examination of the stomach using a flexible viewing tube (upper endoscopy).
Treatment is with antibiotics and a proton pump inhibitor.
(See also Introduction to Gastritis and Peptic Ulcer Disease.)
Infection with Helicobacter pylori is the most common cause of gastritis and peptic ulcer disease worldwide. Infection is very common and increases with age. By age 60, about 50% of people in the United States are infected. However, recent studies show fewer young people are becoming infected with H. pylori. Infection is most common among Black, Hispanic, and Asian people.
H. pylori infects the lining of the stomach and can also be found in stool, saliva, and plaque on the teeth. H. pylori can be transmitted from person to person, especially if people who are infected do not thoroughly wash their hands after a bowel movement. Because people may also spread the bacteria through kissing or other close contact, infections tend to cluster in families and among people who live in nursing homes and other supervised facilities.
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H. pylori bacteria grow in the protective mucus layer of the stomach lining, where they are less exposed to the highly acidic juices produced by the stomach. Additionally, H. pylori produces ammonia, which helps protect it from stomach acid and enables it to disrupt and penetrate the mucus layer.
Complications of H. pylori infection
Virtually all people who have H. pylori infection have stomach inflammation (gastritis), which may affect the entire stomach or only the lower part (antrum). Infection can sometimes lead to erosive gastritis and perhaps even a stomach (gastric) ulcer.
H. pylori contributes to ulcer formation by increasing acid production, interfering with the stomach's normal defenses against stomach acid, and producing toxins.
Long-term infection with H. pylori increases the risk of stomach cancer.
Symptoms of H. pylori Infection
Many people whose gastritis is caused by H. pylori infection do not have symptoms or complications such as a peptic ulcer of the stomach or duodenum.
People who do develop symptoms resulting from H. pylori infection have those that are typical of gastritis, including indigestion and pain or discomfort in the upper abdomen.
Ulcers caused by H. pylori infection cause symptoms similar to ulcers caused by other disorders, including pain in the upper abdomen.
Diagnosis of H. pylori Infection
Tests of breath or stool
Sometimes upper endoscopy
H. pylori can be detected with tests that use breath or stool samples.
Sometimes doctors use a flexible viewing tube (endoscope) to do an upper endoscopy to obtain a sample (biopsy) of the stomach lining. The sample can be tested for H. pylori by several methods.
Treatment of H. pylori Infection
Antibiotics and a proton pump inhibitor
After treatment, tests to confirm eradication of H. pylori infection
The most common treatment for H. pylori infection is a combination of a proton pump inhibitoramoxicillin, clarithromycin, and tetracycline may cause diarrhea. Bismuth subsalicylate may cause constipation and darkening of the tongue and stool.
Doctors typically confirm that treatment was successful by repeating breath or stool tests or endoscopy about 4 weeks after treatment is finished.
Treatment is repeated if H. pylori is not eradicated.
Prognosis for H. pylori Infection
If H. pylori infection is fully eradicated, there is a less than 10% chance a peptic ulcer will return within 3 years. If H. pylori infection is not fully eradicated, there is a greater than 50% chance a peptic ulcer will return in 3 years. In addition, treatment of H. pylori infection may heal ulcers that were not healed with previous treatment.
