Helicobacter pylori: myths and reality

Helicobacter pylori infection is one of the most common bacterial infections in the world, affecting more than half of the human population. Yet many people know little about it, or hold misconceptions that can cause anxiety and unnecessary fears. In this article, with the help of experts from the Endomedix Gastroenterology Centre, we will dispel the most common misconceptions and outline the current medical consensus on diagnosis and treatment.

Helicobacter pylori (H. pylori) is a spiral-shaped, Gram-negative bacterium that was identified in 1983 by two Australian researchers, Barry Marshall and Robin Warren. Their discovery, for which they were awarded the Nobel Prize in Physiology or Medicine in 2005, revolutionised our understanding and treatment of gastric and duodenal ulcers, as well as chronic gastritis. Previously, these conditions were mainly attributed to stress and poor diet; we now know that in most cases this bacterium is the underlying cause.

What makes H. pylori unique is its ability to survive in the highly acidic environment of the stomach. It achieves this by producing an enzyme called urease, which breaks down urea into ammonia, thereby neutralising the stomach acid in the bacterium’s immediate surroundings. This mechanism enables it to colonise the stomach lining, where it can cause chronic inflammation. Although a significant proportion of those infected (approx. 80%) are asymptomatic, in others it can lead to serious symptoms and illnesses.

Our aim is to dispel the myths surrounding Helicobacter pylori and to help you understand this condition by providing reliable, medically substantiated information. Below, we examine the most common misconceptions in detail and provide practical advice on diagnosis and treatment.

The 10 most common misconceptions about Helicobacter pylori infection

Misinformation and myths circulating online often cause more alarm than the disease itself. Let’s take a look at the most common misconceptions and the scientific facts.

1. Myth: „A Helicobacter infection always causes severe symptoms.”

The reality: This is one of the most common misconceptions. The vast majority of people infected with Helicobacter pylori – around 80% – are completely asymptomatic. Many people live with the bacterium for decades without realising it. The presence of the infection does not in itself constitute a disease. The onset of symptoms depends on a number of factors, including the patient’s genetic makeup, the state of their immune system, their lifestyle and the virulence (aggressiveness) of the bacterial strain. When symptoms do occur, they most commonly include the following:

• Pain or discomfort in the stomach area
• Bloating, feeling of fullness
• Frequent burping
• Loss of appetite
• Vomiting

It is important to understand that asymptomatic carriage does not rule out the risk of long-term complications, but infection does not necessarily mean immediate and severe illness.

2. Myth: „If I’m infected with Helicobacter, I’m bound to develop a stomach ulcer or stomach cancer.”

The reality: Although H. pylori is the most significant known risk factor for peptic ulcer disease (stomach and duodenal ulcers) and gastric cancer, only a small proportion of those infected go on to develop these serious complications.

• Peptic ulcer disease: Approximately 10–15% of those infected develop an ulcer at some point in their lives. H. pylori is detectable in more than 90 per 1,000 cases of duodenal ulcer and in 70–90 per 1,000 cases of gastric ulcer.
• Stomach cancer: The risk of stomach cancer is 3–6 times higher among those infected than among those who are not infected. However, fewer than 1% of those infected go on to develop stomach cancer. The bacterium also plays a role in the development of gastric MALT lymphoma (a rare tumour of the lymphatic system), but this is an even rarer complication than stomach cancer.

There is therefore a risk, but infection does not necessarily lead to a diagnosis of cancer. Regular medical check-ups and timely treatment of the infection significantly reduce the likelihood of these complications.

3. Myth: „A Helicobacter infection is as easy to catch as a cold.”

The reality: H. pylori is transmitted from person to person, but not as easily as respiratory viruses. The exact mode of transmission is still the subject of research, but the most likely routes are faecal-oral and oral-oral contact. In practice, this means the following:

• Poor hygiene conditions: The infection is more common in areas where public health conditions and personal hygiene are inadequate. Consuming contaminated food or water can also be a source of infection.
• Transmission within the family: The bacterium is often transmitted between family members through close contact, such as sharing cutlery. People often contract the infection during childhood.

Good hand hygiene and adherence to food safety rules reduce the risk of infection.

4. Myth: „Helicobacter infection is caused by stress and spicy food.”

The facts: Stress and spicy foods do not cause H. pylori infection. The infection is caused by a bacterium. However, these factors can exacerbate existing stomach problems (e.g. gastritis, ulcers) and worsen symptoms. Stress can affect stomach acid production and the functioning of the immune system, whilst spicy foods can irritate the inflamed stomach lining; however, the underlying cause is the bacterial infection itself.

5. Myth: „A Helicobacter infection cannot be eradicated; it always comes back.”

The reality: Helicobacter pylori infection can be successfully treated and eradicated. A combined course of medication (usually lasting 14 days and comprising several types of antibiotics and an acid-reducing drug), administered in accordance with modern medical protocols, is successful in more than 80–90% of cases. Following treatment, the risk of reinfection is low in developed countries, at around 1–2% per year. The most common causes of treatment failure are:

• The patient is not taking their medication as prescribed.
• The bacterial strain is resistant to the prescribed antibiotics.

Following an unsuccessful first course of treatment, second- or third-line treatment regimens are available, which in most cases can achieve complete eradication of the bacteria.

6. Myth: „The Helicobacter test is painful and dangerous.”

The facts: There are several painless and safe methods for detecting Helicobacter pylori. These are divided into two main groups:

• Non-invasive (non-surgical) tests: These are the most commonly used procedures.
  • Urea breath test (UBT): The patient drinks a special liquid or takes a capsule containing urea. If the bacterium is present in the stomach, its urease enzyme breaks down the urea, and a labelled carbon isotope becomes detectable in the exhaled air. This is the most accurate non-invasive test for detecting an active infection and monitoring the success of treatment.
  • Stool antigen test (SAT): It detects a specific protein (antigen) produced by the bacterium in a stool sample. It is also a highly reliable method for confirming an active infection.
  • Serological (blood) test: It detects antibodies produced in response to the bacterium in the blood. A drawback is that it cannot distinguish between an active infection and a previous infection that has already run its course (or been successfully treated), as antibodies can remain in the body for a long time even after the infection has been cleared. It is therefore not suitable for monitoring the success of treatment.
• Invasive test (involving a procedure):
  • Tissue sample taken during a gastroscopy: During the examination, the gastroenterologist takes a tissue sample (biopsy) from the lining of the stomach. This sample can be used for a number of different tests:
    • Rapid urease test (RUT): The tissue sample is placed in a gel containing urea. The presence of bacteria is indicated by a colour change in the gel within a matter of minutes to hours.
    • Histopathological examination: The pathologist examines the sample under a microscope and directly identifies the bacteria and assesses the extent of the inflammation.
    • Breeding: They are attempting to culture the bacteria on a special medium, which also makes it possible to determine its sensitivity to antibiotics.

A gastroscopy is generally indicated if the patient has alarming symptoms (e.g. bleeding, difficulty swallowing, weight loss) or if complications are suspected. The specialists at the Endomedix Gastroenterology Centre always recommend the most appropriate diagnostic procedure based on the patient’s symptoms and condition, whilst ensuring the least possible discomfort.

7. Misconception: „One course of antibiotics is enough for treatment.”

The reality: H. pylori is an extremely resilient bacterium. Hidden away in the acidic environment of the stomach and beneath the mucous layer, it is difficult to eradicate. A single antibiotic is ineffective against it and would quickly lead to the development of resistance. For this reason, combination therapy is always used, which generally consists of the following:

• Two different antibiotics: Their purpose is to kill bacteria.
• Proton pump inhibitor (PPI): A potent acid-reducing medicine that inhibits the production of stomach acid. This serves a dual purpose: on the one hand, it enhances the effectiveness of antibiotics (as they work better in a more alkaline environment); on the other hand, it aids the healing of the inflamed mucous membrane.
• Bismuth salt (in certain treatment regimens): Bismuth compounds form a coating on the mucous membrane and also have a direct antibacterial effect.

To ensure success, the treatment must be carried out for exactly the duration (usually 14 days) and at the dosage prescribed by the doctor.

8. Myth: „If someone in the family is infected, everyone must be tested and treated immediately.”

The reality: As the infection often spreads within families, the question arises as to whether asymptomatic family members should be screened. According to current international and national professional guidelines, routine screening and treatment of asymptomatic adults is generally not recommended. Screening is justified if a family member has had stomach cancer or if a family member is experiencing symptoms. The decision must always be made on a case-by-case basis, in consultation with a specialist gastroenterologist.

9. Myth: „Natural remedies, such as garlic or probiotics, eradicate Helicobacter.”

The reality: There is no scientific evidence to suggest that any natural remedy, diet or dietary supplement is capable, on its own, of eradicating a Helicobacter pylori infection. Although certain substances (e.g. broccoli sprouts, garlic, ginger, turmeric, certain probiotic strains) have shown antibacterial effects under laboratory conditions, these are not a substitute for drug treatment in clinical practice. Probiotics may be useful in alleviating the side effects of drug therapy (e.g. diarrhoea) and in restoring the balance of the gut flora, but they do not achieve eradication.

10. Myth: „After treatment, I can eat and drink whatever I like.”

The reality: Successful treatment eradicates the bacteria and eliminates the main cause of chronic inflammation, which allows the stomach lining to regenerate. However, the healing process takes time. In the weeks and months following treatment, it is advisable to continue avoiding foods and drinks that may irritate the stomach. These include overly spicy, fatty or heavy foods, fizzy drinks, coffee and alcohol. It is important to eat regular, leisurely meals and to avoid smoking, as these factors can slow down recovery and increase the likelihood of symptoms returning.

When should we see a doctor?

If you experience any of the symptoms listed above, particularly if they are persistent, you are strongly advised to consult a gastroenterologist. A medical examination is particularly important if you experience the following „alarm” symptoms:

• Difficulty or pain when swallowing
• Repeated vomiting
• Blood in the stools (black, tarry stools) or in the vomit (coffee-ground-like)
• Unexplained weight loss
• Severe, unremitting abdominal pain
• Anaemia (pallor, weakness, fatigue)

The experienced specialists at the Endomedix Gastroenterology Centre are on hand with modern diagnostic tools and a personalised treatment plan to provide you with the most accurate diagnosis possible and ensure you receive the most effective treatment in a calm, empathetic environment.

Summary: What should we take home?

Helicobacter pylori infection is a common but easily treatable condition. It is important not to rely on misconceptions, but to seek information from reliable sources, such as a doctor. The key messages are:

1. Infection does not necessarily mean illness: many people carry the bacteria without showing any symptoms.
2. Serious complications are rare: although there is a risk, only a small proportion of those infected develop ulcers or tumours.
3. Diagnosis is simple and painless: breath and stool tests are reliable methods that do not require any uncomfortable procedures.
4. The treatment is effective: modern drug therapies eradicate the pathogen permanently in the majority of cases.
5. Do not hesitate to consult a doctor: if you have persistent symptoms, a specialist examination is essential to ensure an accurate diagnosis and appropriate treatment.

If you are experiencing stomach problems or are unsure whether you have a Helicobacter pylori infection, please do not hesitate to contact the specialists at the Endomedix Gastroenterology Centre.