Symptoms of Helicobacter pylori

The symptoms of Helicobacter pylori are caused by an infection of the stomach with this bacterium, which is responsible for more than 90% of duodenal ulcers and up to 80% ofstomach ulcers.

The bacteria can weaken the inner protective layer of the stomach, so that the stomach walls are irritated by the digestive juices.
About two-thirds of the world’s population has Helicobacter pylori.


What diseases does the pathogen Helicobacter pylori cause?

Most people infected with H. pylori do not experience any symptoms that may be related to the infection.
H. pylori can provoke active, chronic, atrophic and persistent gastritis, both in adults and children.

Helicobacter infection is also responsible for stomach and duodenal ulcers.
Infected individuals are two to six times more likely to develop stomach cancer and MALT lymphoma (Mucosa Associated Lymphoid T issue) than uninfected individuals.

Causes of Helicobacter pylori

The bacterium H. pylori can be transmitted through direct contact with saliva, vomit or stool. A spread through water or food is also possible. Infection usually occurs in childhood.

How do you get infected?

Most people become infected with H. pylori as a child. Only rarely does the infection occur in adulthood.
The risk factors for infection by H. pylori are related to childhood circumstances, such as many people living together in a confined space; in this case, the risk of transmission is increased.

Risk factors include:

  • Environment without hot water.
    With hot water, the living space can be cleaned more thoroughly, which reduces the risk of H. pylori.
  • Living in a developing country.
    Those who live in a developing country, where unhealthy living conditions often prevail and the rooms are overcrowded, have a higher risk of becoming infected with Helicobacter pylori.
  • Living with a person infected by H. pylori.
    If you live with someone infected with Helicobacter, infection is more likely.

How is the transmission carried out in Helicobacter pylori

Transmission occurs through food (vegetables, etc.) polluted and unwashed by human excrement, or by drinking from the same bottle or glass.
The bacterium can enter the mouth when vomiting, but the mouth is only a temporary location where H. pylori cannot survive for long. Therefore, transmission by kissing is to be regarded as insignificant.
Helicobacter is not transmitted by:

  • Sexual intercourse
  • Pets
  • Tattoos
  • Blood transfusions
  • Dental treatments

Signs and symptoms of Helicobacter pylori

Anyone can become infected with Helicobacter pylori without knowing anything about it, because it is a “quiet” disease without symptoms. If symptoms occur, these are usually those of gastritis or a stomach ulcer.
In children, gastritis is typically manifested by nausea, vomiting and abdominal pain.
However, these symptoms also occur with numerous other childhood diseases.
Helicobacter pylori, formerly also known as Campylobacter pylori, can also cause stomach and duodenal ulcers (gastroduodenal peptic ulcer disease).

In children with peptic ulcer, bleeding may occur; the blood is either vomited (hematemesis) and the vomit has a bright red color or coffee bean-like appearance, or it is excreted with the bowel movement (tarry stool, melana).
Smaller children with stomach ulcers may not have any visible symptoms, then the diagnosis of the disease becomes difficult.

Symptoms in adults
The main symptom of gastroduodenal peptic ulcer disease is stomach pain or burning in the stomach. As a rule, the pain occurs on an empty stomach, between meals and in the early morning, but it can also be noticeable in other moments.

They can last a few minutes or several hours and can be relieved by food intake or the intake of acid blockers.
Less common symptoms of gastric and duodenal ulcer are nausea, vomiting, gastroesophageal refluxwhite tongue coating and loss of appetite.
Bleeding may also occur, which may lead to anemia if prolonged for a long time.

Helicobacter pylori promotes the development of rosacea (disease of the facial skin with redness and swelling) and there are studies on a possible link between the bacterium and chronic hives.
Patients also report bad breath.
This bacterium does not cause typical intestinal complaints such as diarrheaflatulence or bloating.

The Journal of Medical Microbiology has published a new study from Japan’s Fukuoka Dental College showing that the bacterium Helicobacter pylori is able to survive in the mouth and lips as well. In addition, it can cause periodontal infection, resulting in the production of sulfides responsible for bad breath.

Is Helicobacter pylori dangerous? Possible complications

Gastric and duodenal ulcers H. pylori is the main cause of stomach and duodenal ulcers
About 3 in 20 people infected with H. pylori develop an ulcer. An ulcer is an injury to the mucous membrane and wall of the stomach.

duodenum. The wound is caused by the acid formed in the stomach. Thus, the underlying tissue is exposed to stomach acid.
If you take a look inside the body, an ulcer presents itself like a small red crater in the inner wall of the stomach or duodenum.

How exactly the pathogen H. pylori causes the ulcer in some of the infected people is not entirely clear.
The stomach normally makes quite a bit of stomach acid to help digest food and kill bacteria. This acid is corrosive.
Some cells of the stomach and duodenal walls produce a natural barrier of mucosa that protects the stomach and duodenum from the acid.
Normally, there is a balance between the amount of stomach acid formed and mucosa.

If this balance is disturbed and stomach acid injures the inner wall of the stomach or duodenum, an ulcer may develop.
H. pylori sometimes causes inflammation of the inner wall of the stomach or duodenum.
Thus, the acid can violate the protective barrier consisting of mucosa.
Helicobacter pylori sometimes leads to an increased production of stomach acid.

Some scientists believe that Helicobacter pylori can cause aphthae in the mouth.

Irritable stomach (functional or non-ulcerative dyspepsia)
In this disease, digestive disorders (dyspepsia) are noticeable again and again, which are not caused by stomach ulcers or inflammation.
H. pylori is also present in individuals suffering from non-ulcerative dyspepsia.

As a rule, the cause of the irritable stomach is unknown.

Stomach cancer The risk of developing a stomach tumor increases if a Helicobacter infection persists for a long time.
However, it should be noted that in the UK, more than a quarter of the population is infected by this bacterium, but the vast majority do not develop stomach cancer.

The risk is only minimally increased. It can get bigger if you have H. pylori and at least one first-degree relative (parents, siblings or children) has stomach cancer.
Mucosa-associated gastric lymphoma is a rare and unusual form of stomach cancer; infection by H. pylori appears to play an important role in the development of this disease.

How is infection by H. pylori detected?

The problem with this infection is that doctors often confuse it with simple gastritis.
Then gastritis is treated for years before it is determined that this bacterium is the real problem.

Diagnosis of Helicobacter pylori

There are some very accurate and simple tests to detect Helicobacter pylori infection.

These include: blood test for an antibody test, breath test, antigen test and endoscopic sampling (biopsies).
The blood test for antibody analysis (IgG and IgA are examined) is easy and quick to perform.
However, the antibodies can remain in the blood for years after the complete eradication of Helicobacter pylori by antibiotics.

Thus, a blood test is useful for diagnosing the infection, but is not suitable for finding out whether the bacterium could be completely destroyed.

The breath test is a safe, simple and precise method to detect the presence of Helicobacter pylori in the stomach.
The breath test is based on the ability of Helicobacter pylori to naturally split urea and release carbon dioxide, which is absorbed by the stomach and excreted from the body via the breath. 10-20 minutes after the patient swallows the radiolabeled urea in the form of a capsule, the labeled carbon dioxide can be detected in the exhaled air.

If labelled carbon dioxide occurs in the breathing air (positive test result), there is an active infection. The test is negative (no marked CO2 in the exhaled air) as soon as the bacterium has been eradicated in the stomach with the help of antibiotics (eradication).
Since even small amounts of radioactivity worry patients, the test has been modified so that it can also be carried out with non-radiolabelled urea.
The test kit for Helicobacter pylori detection by means of breath test can be obtained on prescription in any pharmacy.
Normal test results (negative test) of the breath test are between 0 and 4, but the result may vary depending on the laboratory.

gastroscopy is a very accurate examination method for the diagnosis of H. pylori, as well as the inflammation and ulcers caused by it. The doctor inserts a movable tube (gastroscope) through the mouth into the esophagus to the stomach or duodenum.

During gastroscopy, small tissue samples (biopsies) can be taken from the stomach wall.
A sample containing urea is analysed on a slide. When the urea is altered by H. pylori, the tissue edge has a color change.
This means an H. pylori infection in the stomach.

In a newer test procedure, Helicobacter pylori detection is carried out by examining the stool.
An antibody of Helicobacter pylori is used to determine the occurrence of the bacterium in the stool.
Like the breath test, it can be used shortly after treatment to check the successful eradication of the bacterium.
In 2012, the U.S. Food and Drug Administration (FDA) approved the breath test for children from 3 to 17 years of age.

Therapy for Helicobacter pylori, which antibiotics help?

There are several ways to treat H. pylori infection:

  • Antibiotics to kill the bacteria
  • Medications such as H2-antihistamines (also H2receptor antagonists) and proton pump inhibitors (PPIs) to reduce stomach acid

To the H2-Antihistamines include:

  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
  • Nizatidine
  • Cimetidine (Tagamet)

Commercially available proton pump inhibitors are:

  • Omeprazole (Antra MUPS, Gastracid, etc.)
  • Lansoprazole (Lanzor or Agopton)
  • Pantoprazole (Rifun, Pantozole, Pantoloc)
  • Esomeprazole (Nexium, etc.)

Antacids, H2-Receptor antagonists and proton pump inhibitors do not completely eliminate Helicobacter pylori and the ulcers often come back as soon as the drugs are discontinued.

Therefore, acid blockers, H2-receptor antagonists and PPIs are taken every day for many years to prevent recurrence of stomach ulcers and complications such as bleeding, gastric rupture and stomach constriction.
The complete elimination (eradication) of Helicobacter pylori usually prevents the recurrence of peptic ulcers and their complications even after discontinuation of the PPI.

Sodium bicarbonate is an acid-neutralizing agent (antacid) and can be used to treat the infection, but the benefits are short-lived.

H. pylori often remains in the stomach because it is resistant to most antibiotics. Therefore, two or more antibiotics are administered together with a PPI and/or bismuth containing drugs to eradicate the pathogen. (Bismuth and PPI have an anti-H. pylori effect). Examples of effective pharmacological combinations:

  • A PPI + amoxicillin (amoxicillin ®, amoxibeta ®) and clarithromycin (Biaxin, Klacid)
  • A PPI+ amoxicillin and levoflaxacin (Tavanic ®)
  • A PPI + metronidazole (Flagyl), tetracycline and bismuth oxide salicylate

With these combinations, 70-90% of infections can be cured. However, studies have shown that H. pylori are often resistant to clarithromycin if patients have previously been treated with clarithromycin or other chemically similar macrolide antibiotics (e.g. erythromycin).

Likewise, resistance of H. pylori to metronidazole is often found if metronidazole has previously been administered. For such patients, doctors have identified other combinations of antibiotics to combat Helicobacter pylori.

Pregnant women should seek treatment as soon as possible so that the bacterium is not transmitted to the child.

Natural remedies for Helicobacter pylori

While there is no miracle cure that kills all Helicobacter pylori bacteria living in the stomach, there are certain methods that make their environment inhospitable.
We know that the bacterium only lives in an acidic environment. If it is to be combated without drugs, its habitat must be changed.
To reduce the acidity in the stomach, you can increase the water intake so that the stomach acid is diluted; for this purpose, drink at least 2-3 liters of water a day.
The water should be consumed outside meals, if the stomach does not produce additional stomach acid; this makes it easier to achieve the desired result.
This measure is effective if a few meals are taken a day, such as breakfast, lunch and dinner.
If you eat something every 3 hours, you constantly have a certain amount of food and stomach acid in your stomach: an ideal environment for the bacterium.

In addition, to enhance the effect of the water, an alkaline substance called microhydrin can be applied, which further reduces the acidity of the stomach.

The American College of Gastroenterology has established the following guidelines for controlling Helicobacter pylori:

Surgical intervention for the treatment of peptic ulcer.
As a rule, doctors advise to refrain from spicy, fatty and acidic foods.
However, it has been noted that the diet has little or no effect on ulcers in most people.
Smoking can interfere with the healing of ulcers and appears to play a role in relapses.
The appropriate treatment depends on a number of factors, including:

  • Age, health and medical history
  • Severity of infection and stomach damage
  • Tolerability of certain medications or treatments
  • personal preferences

As with most diseases, prevention is the best treatment for H. pylori. There is no vaccination against H. pylori.

How can infection by H. pylori be prevented?

Since the origin of H. pylori is still unknown, there are no recommendations to avoid this infection. Basic behavioral measures are thorough hand washing, only consumption of correctly prepared food and bottled mineral water.

Read more