H. pylori: what is it? See symptoms, what to eat and treatment

The H. pylori is a bacterium that is installed on the inner walls of the stomach, causing inflammation, heartburn , feeling of bloating, reflux, bad breath and gastritis .

It is estimated that about 50% of the world population is infected with this bacterium, although only a small portion develops the symptoms of the infection.

The countries with the highest number of cases are in Africa, Latin America and Asia, with a rate of 70% to 90% of infections.

Although there is no consensus between doctors and health professionals, it is believed that H. pylori can be transmitted from person to person through saliva.

Do you want to know more about H. pylori ? Then follow the article to the end and learn how to prevent and treat the infection!


What is H. pylori ?

The H. pylori is a bacterium that is housed in the inner walls of the stomach human, causing heartburn, stomach pain, feeling of fullness and bad breath. If left untreated, it can lead to gastritis and even ulcers.

Unlike other bacteria, H. pylori secretes a chemical substance (urease) that neutralizes the acids produced in the human stomach, allowing it to live in that environment without harming itself.

This bacterium most often affects children under 6 years old, people with economic weakness and inhabitants of regions with basic sanitation problems.

Contagion usually occurs through ingestion of contaminated food or water. For this reason, the infection is more frequent in poor regions with problems of basic sanitation.

The worsening of the infection can lead to the appearance of ulcers, in addition to being a risk factor for the development of stomach cancer .

This causes the World Health Organization (WHO) to consider H. pylori as a carcinogen.

Causes: how do you get the H. pylori bacteria ?

The H. pylori can be acquired through ingestion of water and food contaminated with feces, or after examinations with medical devices containing the bacteria. Although it is not a consensus, it is possible that some people are infected by fecal-oral transmission:

Contagion via fecal-oral route

In poor countries with basic sanitation problems, drinking water or food that has been contaminated with feces containing H. pylori is a very recurrent form of infection.

In these places, it is not uncommon for the water used to irrigate crops to be contaminated with waste coming from sewage networks.

The lack of efficient treatment of the water supplied to the population also increases the risk of contagion, placing people in a position of vulnerability.

When a person consumes raw vegetables and without proper hygiene, the bacteria that are contained on the surface of these vegetables end up entering the body through the mouth.

Thus, when it enters the body, it moves through the digestive system until it reaches the stomach or reaches the small intestine.

Contagion after clinical procedures

It is also called iatrogenic contagion and refers to infections caused after clinical procedures. In the case of H. pylori , it usually happens as a result of endoscopies performed with poorly sterilized instruments.

According to the World Health Organization (WHO), this form of transmission is less common. However, health professionals should be aware of the sterilization processes in clinics and outpatient clinics.

Is H. pylori transmissible?

Yes. There are indications that H. pylori can be transmitted through contact with the saliva or other body fluids of infected people, such as vomiting.

However, the way in which this transmission occurs has not been fully clarified.

Some studies suggest that when a person suffers from reflux, part of the bacteria that remains in the stomach goes up through the digestive canal next to the gastric acid, reaching the patient’s throat and mouth.

In the mouth, they could be transmitted through saliva or when people share food or utensils (spoons and glasses). However, these cases of infection are more rare.

Another factor that seems to contribute to the transmission of H. pylori is the lack of personal hygiene, such as the habit of not washing your hands properly before meals and after using the bathroom.

Handling food with bacteria-contaminated hands can cause fecal-oral infection.

Risk factors

Although anyone can get H. pylori , people from unhealthy regions without basic sanitation are more prone to infection. Know more:


Infection with H. pylori is more common in children, especially in countries with sanitation problems.

Research shows that while the infection rate in children under 10 years varies from 1% to 10% in rich countries, in poorer regions this number rises to 50%.

Socioeconomic profile

Living in places without basic sanitation and having a deficient diet means that people who are economically disadvantaged are at a greater risk of contracting H. pylori .

The percentage of infection among residents of orphanages, nursing homes, hospitals and prisons is much higher than that of people with better purchasing power.

The lack of adequate food also increases the chances of infection, as it reduces the defenses of the immune system leaving people more susceptible to diseases.

Lack of basic sanitation

As the transmission occurs through the ingestion of water contaminated with feces, inhabitants of regions without basic sanitation have the highest rates of infection by H. pylori .

According to data collected by the Trat Brazil Institute in 2019, about 35 million Brazilians still do not have access to drinking water and 95 million are without sewage collection.

Most of these people live in the North and Northeast regions, however, large cities in the Southeast region, such as São Paulo and Rio de Janeiro, also have deficient sanitation.

As a consequence, the population has high rates of hospitalization due to infections caused by microorganisms, such as H. Pylori .

What are the symptoms of H. pylori infection ?

Most people infected with H. pylori have no symptoms. However, some patients may suffer from stomach discomfort, reflux, bad breath, belching, heartburn and digestion problems.

In addition to these symptoms, infected people may have the following conditions:

Reflux, bad breath and belching

To live in the human stomach without harming its acidity level, the H. pylori bacterium secretes an enzyme called urease. This enzyme breaks down urea, a substance present in gastric juice, and converts it into carbon dioxide and ammonia.

Both carbon dioxide and ammonia are harmful to the stomach.

In addition to causing reflux, belching and bad breath in the patient, these substances also neutralize the hydrochloric acid involved in the digestion process.


Heartburn is a burning sensation that can affect both the walls of the stomach and the region of the esophagus, when the patient suffers from reflux.

The burning is caused by the acidic substance produced in the stomach and usually manifests itself after meals.


Although H. pylori normally neutralizes gastric acid, it can also increase the stomach acid level.

When this occurs, the patient may develop a condition of hypochlorhydria, which consists of an upset stomach due to problems in the digestion of food.

The main manifestations of hypochlorhydria are bloating, a feeling of fullness and gas .

Diagnosis: how do I know if I have H. pylori ?

There are several tests that help to check for the presence of H. pylori in the stomach. Generally, gastroenterologist doctors opt for less invasive methods, such as a blood test, stool test or exhaled air test.

However, in severe cases of gastritis, the most recommended may be an endoscopy or biopsy of the stomach tissue.

The tests mentioned above will only be indicated after a medical evaluation that will take into account the presence of the following symptoms:

  • Asia;
  • Reflux, belching, constant bad breath;
  • Stuffing sensation;
  • Nausea;
  • Hypochlorhydria (digestion problem).

What tests detect H. pylori ?

Infection with H. pylori can be detected by blood tests, stools, or breathing test with marked urea.

Patients suffering from severe stomach problems, such as chronic gastritis or ulcers, can also detect H. pylori through endoscopy and the urease test.

Better understand each exam:

Blood test

It is done by analyzing a blood sample, in order to detect the presence of antibodies to H. pylori in the body.

Although blood tests help in the initial diagnosis of the infection, they are not able to tell whether the organism has actually eliminated the bacteria after treatment.

This is because even after using antibiotics , the immune system continues to produce antibodies to H. pylori .

Thus, blood tests can continue to show the presence of this bacterium in the stomach even after treatment.

To avoid false positive results, experts recommend that other tests be performed after treatment, such as examining stool or exhaled air.

Stool examination

Stool examination can be done to check for the presence of bacteria in the stool of patients with suspected H. pylori infection .

This test is advantageous compared to the blood test because it not only detects the presence of antibodies in the body, but also detects other possible active infections.

In addition, it is also an exam that can help prevent colorectal cancer.

To do this exam, it is necessary that the patient has been without medication for at least 2 weeks, such as antibiotics and antacids.

Exhaled air examination

This test is done to detect the presence of substances secreted by the bacteria in the air exhaled by the patient.

The test is carried out as follows: the patient ingests a substance containing 75 mg of urea and powdered carbon dissolved in water.

After a period of approximately 40 minutes, it exhales air in a container containing a pH (acidity level) marker.

If the presence of substances secreted by the bacteria in the exhaled air is registered, there is a change in the color of the marker due to the increase in the level of acidity, which means a positive result for the presence of H. pylori .

For this test to be performed, the patient must be fasting (minimum of 6 hours) and not using antibiotics, since the performance of these drugs can interfere with the test result.

Before the procedure, the patient should consume 200mL of orange juice or 1g of citric acid dissolved in 200mL of water.

The examination of exhaled air can take around 2 days to be ready.


Endoscopy is an examination performed with the aid of an endoscope, a device that allows the specialist to capture images in real time of the internal membranes of the patient’s esophagus, stomach and small intestine.

The endoscope is inserted through the mouth, passing through the esophagus until it reaches the stomach.

In addition to helping diagnose inflammation in stomach membranes, the endoscope allows tissue fragments to be removed for biopsies.

Although the procedure can cause mild discomfort to the patient, it is done with intravenous and local anesthesia, causing no pain.

Urease test

The urease test is done during endoscopy and consists of the analysis of small fragments of tissue taken from the internal wall of the stomach.

These fragments are placed in a container containing urea and a pH marker. The presence of the bacteria will be measured based on the level of acidity found in the urea, which will change color if the pH increases.

If the bacteria is present in the tissues removed from the stomach, the urea reacts by changing from yellow to red, indicating a positive result. If the urea does not change color, the result is negative for H. pylori .

The test can take anywhere from a few minutes to hours to get ready.

As with other exams, the patient must stop using medication for the period determined by the doctor.

H. pylori tern care?

Yes. Infection with H. pylori can be cured when the patient receives the diagnosis, treatment with antibiotics and adopt healthy eating habits.

To see if the bacteria has actually been eliminated from the stomach, the doctor may ask the patient to do a stool test or an exhaled breath test again.


Treatment for H. pylori infection lasts 10 to 14 days and involves the use of antibiotics and proton pump inhibitor (PPI) drugs.

These remedies are used to fight infection, directly attacking H. pylori .

For them to take effect, it is essential that they are taken at the correct time and period

Treatment with inhibitors of gastric acid production, also known as proton pump inhibitors, decreases the symptoms of heartburn, gastritis and reflux.


There are two main types of drugs used to treat H. pylori infection : antibiotics and proton pump inhibitors. Know more:


Antibiotics have the role of eliminating the infection, directly attacking the bacteria present in the stomach membranes.

For the treatment to be successful, the patient must carefully follow the medical guidelines in relation to the times and for how many days he must keep the medication.

The remedies commonly prescribed for the treatment of H. pylori are:

  • Amoxicillin ;
  • Clarithromycin ;
  • Levofloxacin ;
  • Furazolidona.

Proton pump inhibitors

PPIs are drugs that suppress up to 95% the secretion of gastric acid in the stomach, relieving the symptoms of heartburn, gastritis and gastrointestinal reflux.

In the case of peptic disease, PPIs promote the healing of lesions and ulcerations present in the stomach membranes.

In addition, when used in conjunction with antibiotics in the treatment of patients with H. pylori , PPIs increase the chances of complete remission of the infectious condition.

Generally, remedies include:

  • Omeprazol;
  • Pantoprazole ;
  • Lanzoprazol;
  • Tenatoprazole;
  • Rabeprazole ;
  • Esomeprazole .


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

People with H. pylori can adhere to eating habits that alleviate the symptoms of the infection and help in the recovery of the internal mucous membranes of the stomach, leaving the day to day until the full recovery from the disease more comfortable.

Some changes include:

Be careful with your diet

According to recommendations from gastroenterologist doctors, the diet for people with H. pylori should include some specific foods and others should be avoided. Among those who do well are:

  • White meat (fish, poultry);
  • Vegetables (beans, lentils, chickpeas);
  • Cereals (oats);
  • Cooked vegetables (broccoli, carrots, cabbage);
  • Non-citrus fruits (grape, avocado, melon);
  • Natural juices (cabbage, grapes, apples);
  • Gelatine.

During treatment, the consumption of foods that increase gastric acid production or that cause irritation, such as caffeine, fried foods and products with excess salt, sugar and dyes, should be avoided.

Other foods that should be avoided include:

  • Coffee, teas and caffeinated drinks;
  • Soft drinks;
  • Alcoholic beverages;
  • Fried food;
  • Peppers;
  • Meats;
  • Sausages (hams, sausages, sausages);
  • Industrialized snacks.

Consume prebiotic and probiotic foods

In addition to the foods recommended above, there are also prebiotics and probiotics , which help in the balance of intestinal flora and contribute to good digestion.

Prebiotics are foods that must be consumed to stimulate the activity of microorganisms naturally present in our body.

Some examples of prebiotic foods are:

  • Green banana;
  • Oat;
  • Chicory;
  • Onion;
  • Garlic.

Probiotic foods, on the other hand, are those that contain substances rich in live microorganisms that act in a beneficial way in the body. They help maintain the balance of intestinal flora and absorb vitamins and nutrients.

In Brazil, the most consumed probiotic food is fermented milk enriched with live lactobacilli.

These microorganisms are found naturally in the human intestine, playing a very important role in combating infectious agents, such as H. pylori .

Some probiotic foods are:

  • Natural yogurt;
  • Fermented milk;
  • Kefir;
  • Kombucha.

Avoid lying down right after meals

Taking naps right after meals may seem like a harmless practice, but for the stomach and esophagus this habit is a real poison.

According to a study published in the medical journal Clinical Gastroenterology and Hepatology , symptoms of reflux and burning in the esophagus are worse in patients who take naps throughout the day, especially after heavy meals.

Lying down before the stomach has time to digest food causes both food and gastric juice to rise up into the esophagus, causing irritation and discomfort.

Therefore, it is important to establish a time interval between meals and naps, in addition to avoiding heavy foods before bed.


The chances of a cure after treatment with antibiotics and inhibitors of gastric acid production are very high, even for patients with severe complications, such as the ulcer.

According to the CDC ( Center of Diseases Control and Prevention ), the cure rates can be even higher if the patient undergoes triple therapy, in which 3 different antibiotics are combined.

Alternating antibiotics prevents microorganisms from becoming resistant to drugs.

In addition to drug treatment, specific diets to combat the symptoms of infection also contribute to the patient’s complete healing.


If H. pylori infection is not treated correctly with antibiotics, it can develop into serious stomach problems, such as ulcers and even cancer.

The secretion of substances that hinder the digestion of food can also cause anemia , since the absorption of proteins and vitamins is compromised. Know more:


Gastritis is an inflammation in the inner walls of the stomach caused by an increase in the acidity level of gastric juice.

When H. pylori is present in the stomach, there may be an increase in the production of hydrochloric acid, a substance necessary for the digestion of food.

The increase in gastric juice ends up contributing to the appearance of wounds in the stomach membranes. Symptoms are heartburn, poor appetite, puffiness and reflux.

There are a number of stomach problems that can cause gastritis, so it is very common for patients to discover that they only have H. pylori after performing endoscopies.

Pernicious anemia

To survive in the human stomach, H. pylori secretes enzymes that neutralize the chemicals responsible for the digestion of food.

Two of these substances are gastric acid and the protein called intrinsic factor, responsible for the absorption of vitamin B12 in the body.

When the bacteria interferes with the production of the intrinsic factor, the patient develops pernicious anemia , a subtype of anemia related to the lack of B12 in the body.

As the production of gastric juice is essential to digest food in general, other forms of anemia can also manifest, such as that related to iron deficiency.

Some of the symptoms of pernicious anemia are dizziness , weakness, pallor, lack of appetite and indisposition.

Peptic ulcer

Peptic ulcer occurs when there is overproduction of gastric acid in the stomach, which leads to corrosion of the internal membranes and the appearance of severe inflammation.

The term “peptic” comes from pepsin, an enzyme responsible for digestion.

Symptoms of heartburn and stomach discomfort usually appear after meals, at which point the stomach secretes gastric acid to digest food.

The most common symptoms of peptic ulcer include stomach pain, heartburn, reflux, abdominal pain and in some cases, bloody stools.

Ulcers usually heal in a short time, however, they can also present complications, such as hemorrhage and cancer.

Stomach cancer

The association of H. pylori infection with cancer can be frightening, however, experts say that only a very small proportion of infected people actually develop the disease.

Stomach cancer associated with H. pylori usually appears as a complication of peptic ulcer, a stage in which there is bleeding in the stomach and in the duodenum (upper part of the small intestine), in addition to perforations in the mucous membranes of the stomach.

The symptoms are similar to those of gastritis and peptic ulcer, although they appear more intensely.

When stomach cancer is first discovered, the chances of a cure reach 100%. Therefore, it is essential that the patient visits the doctor periodically.

How to prevent H. pylori infection ?

Infection by H. pylori can be prevented by hygienic measures and improvement of sanitation conditions of the population. Cooking food well and not drinking water that may be contaminated are essential to avoid infection.

Do not eat undercooked food

H. pylori is believed to be transmitted mainly through the consumption of contaminated water or food. For this reason, it is important to wash food thoroughly with running water and sponge before cooking.

In addition to running water, 3% hydrogen peroxide (hydrogen peroxide) also helps to eliminate bacteria present on the surface of fruits and vegetables.

To apply it to food, just put one tablespoon of peroxide for every 1 liter of water and soak the vegetables for 15 to 20 minutes.

Boil water before drinking

Drinking water from unknown sources can increase the risk of H. pylori contagion , so you should avoid using water from wells and sources.

People residing in regions where there is no quality basic sanitation should opt for the consumption of mineral water.

If this is not possible, it is essential that the tap water is boiled before being consumed.

Wash your hands thoroughly

The H. pylori is transmitted by the fecal-oral route, meaning that infected people can accidentally pass it if not well higienizem hands after using the toilet.

Therefore, washing your hands before meals with soap and alcohol gel 70% reduces the risk of contamination of food or oral mucous membranes (mouth and nose).

Infection by H. pylori can be prevented from hygiene habits such as washing your hands thoroughly before meals, do not eat raw foods and avoid drinking water of unknown origin.

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