Many people experience recurring stomach complaints from time to time, but we tend to put these down to stress or a heavy meal. Statistics show, however, that stomach complaints are often caused by a silent but all the more persistent pathogen: Helicobacter pylori. This bacterium affects a significant proportion of the world’s population, and although it may remain asymptomatic for a long time, if left untreated it can lead to serious complications.
The 2025 medical guidelines and the latest scientific findings place greater emphasis than ever before on early detection and targeted treatment. The good news for patients is that diagnostic procedures are now much less invasive and do not always require uncomfortable interventions. The aim of this article is to present, in an accessible manner and based on professional expertise, the nature and symptoms of the infection, as well as the solutions offered by modern gastroenterology.
What exactly is Helicobacter pylori?
Helicobacter pylori is a spiral-shaped bacterium capable of colonising the mucous membrane of the human stomach. What makes it unique is that it survives even in an extremely acidic environment, as it is able to neutralise the stomach acid around itself. The pathogen typically colonises the lower part of the stomach (the antrum), the body of the stomach and the upper part (the fundus).
Infection often occurs during childhood – for example, as a result of sharing a bed, overcrowding or poor hygiene – but symptoms frequently only appear in adulthood, sometimes decades later. The presence of the bacterium causes chronic gastritis, which involves persistent inflammation of the mucous membrane. In the vast majority of cases, this condition goes unnoticed for a long time, but over time it increases the risk of peptic ulcers and other complications.
The effect of the bacterium on the body
Helicobacter pylori is not merely „present” in the body, but actively affects the functioning of the stomach. The bacterium produces enzymes that can damage the protective layer of the stomach lining, allowing stomach acid to come into direct contact with the tissues, causing erosion and ulcers. It is important to understand that, although the infection does not in itself cause disease in everyone, this pathogen is responsible for 70–90% of gastric and duodenal ulcers.
Warning signs: When should you see a doctor?
Based on the latest research and clinical experience, the recommendation in 2025 remains that a consultation with a specialist is warranted in all cases of persistent gastrointestinal symptoms. As the infection may be asymptomatic in around 80% of cases, a diagnosis can often only be made through targeted screening.
If you experience any of the following symptoms, it is strongly recommended that you seek medical advice:
- Stomach pain: This may be a dull, burning sensation in the upper abdomen (below the ribcage), which often occurs after a meal or at night.
- Feeling of discomfort: A persistent feeling of fullness, pressure in the stomach area.
- Nausea and vomiting: Symptoms caused by irritation of the inflamed mucous membrane.
- Bloating and belching: Frequent belching and abdominal distension may be symptoms associated with the infection.
- Loss of appetite: Because they feel full early on, those affected eat less, which can lead to unintentional weight loss.
If, in addition to your symptoms, you also experience so-called „alarm” symptoms – such as bloody or black stools, difficulty swallowing, unexplained anaemia or a palpable abdominal mass – a consultation with a specialist cannot be delayed.
Scientific breakthroughs and the 2025 guidelines
Science is constantly evolving, and this also shapes our understanding of Helicobacter pylori. According to the most recent, authoritative professional consensus (the Maastricht VI/Florence Report) and research conducted since then, the infection is now treated as a form of infectious disease, which it is recommended to eradicate in all cases, even in asymptomatic carriers, once the diagnosis has been confirmed.
The link between dyspepsia and infection
There have also been changes in the management of functional dyspepsia – which refers to epigastric symptoms without any organic lesions. Research suggests that, in some infected patients, eradication of the bacterium may lead to long-term symptom relief. Therefore, according to the 2025 guidelines, one of the first steps for patients suffering from persistent digestive symptoms is to screen for Helicobacter pylori and, if the result is positive, to treat the infection. In many cases, this may eliminate the need for long-term use of acid-reducing medication.
The role of cancer prevention
The World Health Organisation (WHO) has classified Helicobacter pylori as a carcinogen (a substance that causes cancer). This does not mean that every infected patient will develop a tumour – in fact, the rate is less than 1% – but the persistent presence of the bacterium is a significant risk factor. The chronic inflammation caused by the infection can, over time, lead to the wasting away of the mucous membrane (atrophy) and the transformation of cells (intestinal metaplasia), which are considered to be precancerous conditions of stomach cancer. According to the current scientific consensus, the successful eradication of the bacterium eliminates the inflammation and thereby significantly reduces, or may even halt, the onset of cancerous processes.
Diagnostics: Pain-free options
Many patients put off medical examinations because they are afraid of uncomfortable procedures, particularly gastroscopy. However, it is important to emphasise that excellent, non-invasive (non-surgical) methods for detecting Helicobacter pylori are now available at the specialist clinics of the Endomedix Gastroenterology Centre.
Urea Breath Test (UBT)
This diagnostic procedure is the most convenient option for patients. During the test, the patient is asked to drink a special solution containing urea. If Helicobacter pylori is present in the stomach, it breaks down the urea, and the gas produced during this process can be measured in the exhaled air. The test has a sensitivity and accuracy of between 90 and 100 per cent, making it ideally suited for confirming active infection and monitoring the success of treatment. It is important to note that taking antacids and antibiotics may affect the result; therefore, these should be discontinued prior to the test in accordance with the treating doctor’s instructions.
Faecal antigen test (SAT)
During laboratory analysis of a stool sample, the presence of bacterial proteins (antigens) is detected. This method is also painless and confirms an active infection with a high degree of accuracy. It can be particularly useful in children or in cases where it is difficult to carry out the breath test.
When is a gastroscopy necessary?
Although the tests mentioned above are excellent for detecting the bacterium, in certain cases a gastroscopy is unavoidable. If the patient is over 45–50 years of age or has warning signs (weight loss, bleeding, difficulty swallowing), endoscopic examination is essential for assessing the condition of the mucosa and ruling out any ulcers or cancerous lesions. The pathogen can also be detected in a tissue sample (biopsy) taken during the endoscopy, either by histological examination or by a rapid test (RUT).
Treatment of the infection: The aim is complete eradication
If tests confirm the presence of Helicobacter pylori, the aim of treatment is to completely eliminate the bacterium, i.e. eradication. As the pathogen may be resistant, treatment usually involves a combination of medicines and lasts for 10–14 days.
Antibiotic treatments
According to the latest guidelines, treatment is based on a combination of an acid-reducing medicine (proton pump inhibitor – PPI) and several types of antibiotics.
- A bismuth-based four-component combination: This protocol contains an acid-reducing agent, a bismuth compound, tetracycline and metronidazole. It is exceptionally effective, particularly in regions where bacterial resistance to other antibiotics is higher.
- A triple combination containing clarithromycin: An acid-reducing agent combined with amoxicillin (or metronidazole) and clarithromycin.
It is vital to follow the course of treatment exactly as prescribed. Stopping the course of treatment halfway through may not only lead to the treatment failing, but may also contribute to the development of antibiotic-resistant strains.
Monitoring the treatment
Once treatment has been completed, it is always necessary to check that the bacteria have indeed been eradicated from the body. This follow-up test – which is usually a breath test or a faecal antigen test – must be carried out at least 4 weeks after stopping the medication. Following successful eradication, the risk of ulcer recurrence is reduced to a minimum, to less than 10%.
Prevention and lifestyle
Although a vaccine against Helicobacter pylori is still at the research stage, the risk of infection can be reduced by following certain hygiene rules. As the bacterium spreads from person to person and via contaminated water or food, basic hand hygiene and the proper cleaning of food are essential.
In the case of a diagnosed infection, lifestyle changes can help to alleviate the symptoms, although the bacteria cannot be eradicated by diet alone. Giving up smoking is particularly recommended, as tobacco smoke exacerbates damage to the stomach lining and reduces the effectiveness of treatment. Similarly, regular, heavy alcohol consumption and excessive salt intake are environmental factors that can increase the risk of complications.
Why choose the Endomedix Gastroenterology Centre?
The investigation of digestive system complaints is a matter of trust. At the Endomedix Gastroenterology Centre network, we are committed to providing our patients with the most up-to-date diagnostic and therapeutic options, all within a supportive and empathetic environment.
Our specialists carry out Helicobacter pylori screening and treatment in accordance with the latest international guidelines. We take great care to ensure that the tests cause as little discomfort as possible. Pain-free breath tests are available at our clinics, enabling a quick and reliable diagnosis of the infection.
Don’t let stomach ache or digestive problems of unknown origin cast a shadow over your daily life. Early detection and professional treatment are the key to recovery and to preventing future complications.
