Do you often experience abdominal pain, bloating or nausea? Perhaps you’ve already wondered what might be causing these unpleasant symptoms. Many people have no idea that a tiny but particularly stubborn bacterium, Helicobacter pylori, may be to blame. This pathogen affects nearly half the world’s population and is responsible for a number of digestive disorders, including gastritis and ulcers.
In this article, we provide a detailed overview of the most common symptoms of Helicobacter pylori infection, how it is diagnosed, and what modern treatment options are available in the light of the latest scientific findings. Our aim is to provide clear yet accurate information, helping you to understand the possible causes of your symptoms and to take the necessary steps to look after your health with confidence.
What exactly is Helicobacter pylori?
Helicobacter pylori (H. pylori for short) is a spiral-shaped, Gram-negative bacterium capable of surviving and multiplying in the acidic environment of the stomach. Its discovery is attributed to Barry Marshall and Robin Warren, who identified the pathogen on the gastric mucosa of patients suffering from gastritis in 1983. They were awarded the Nobel Prize in Physiology or Medicine in 2005 for their work, as their research revolutionised the treatment of gastric and duodenal ulcers.
The bacterium has a unique survival strategy. It produces the enzyme urease, which breaks down urea in the stomach into ammonia and carbon dioxide. The ammonia neutralises the stomach acid in the bacterium’s immediate surroundings, thereby creating a protective barrier around itself, enabling it to survive in the extremely acidic environment (pH around 2). In addition, it moves actively with the help of its cilia and is able to penetrate the mucus layer protecting the stomach wall to attach itself to the underlying, less acidic (around pH 7) epithelial cells.
The infection spreads from person to person, most commonly via food or water contaminated with faeces (the faecal-oral route), but is also thought to spread via saliva (the oral-oral route). Around 50% of the world’s population carry the bacterium, but a significant proportion of those infected never develop any symptoms.
The most common symptoms of Helicobacter pylori infection
Although up to 80% of those infected with Helicobacter pylori may remain completely asymptomatic, the bacterium can cause a number of unpleasant symptoms as well as more serious illnesses. The presence and severity of symptoms vary from person to person.
Common digestive complaints
The infection is most commonly associated with the following general symptoms:
- Epigastric (stomach area) pain: A dull, burning or gnawing pain in the area below the sternum, which may worsen after meals.
- Bloating and a feeling of fullness: Many patients report an unpleasant feeling of fullness and bloating even after eating just a small amount of food.
- Frequent burping: Due to increased gas production, burping may become more frequent.
- Dizziness and nausea: These symptoms may mainly occur in the morning on an empty stomach, but they can occur at any time of day.
- Loss of appetite and weight loss: Persistent unpleasant symptoms can lead to a loss of appetite and, as a result, unintentional weight loss.
It is important to note that these symptoms are not exclusive to H. pylori infection; they can also be caused by a number of other digestive problems. For this reason, if you experience the above symptoms over a prolonged period, it is strongly recommended that you consult a specialist, such as a Endomedix Gastroenterology Centre consult specialists to obtain an accurate diagnosis.
Diseases and complications associated with the infection
H. pylori can cause more than just temporary discomfort. Its prolonged presence causes chronic inflammation of the stomach lining, which over time can lead to the development of more serious conditions.
- Chronic gastritis (inflammation of the stomach): H. pylori is the most common cause of chronic (type B) gastritis. The inflammation can lead to atrophy of the mucous membrane and changes in its structure (intestinal metaplasia).
- Peptic ulcer disease (Ulcus pepticum): Ulcers develop in approximately 15% of those infected. H. pylori is the causative agent in 90% of duodenal ulcer cases and in 70–90% of gastric ulcer cases. The main symptom of ulcers is a sharp, burning pain, which worsens on an empty stomach and is temporarily relieved by eating. Complications of ulcers may include bleeding (black stools, vomiting blood), perforation (a hole in the stomach wall) or stricture. The latest scientific findings confirm that the successful eradication of H. pylori significantly reduces the incidence of bleeding from gastric and duodenal ulcers.
- Stomach cancer: Against a background of chronic inflammation, mucosal atrophy and intestinal metaplasia are considered precancerous conditions. H. pylori infection increases the risk of developing gastric cancer by a factor of 3–6. The World Health Organisation (WHO) classifies the bacterium as a Group 1 (known) carcinogen. Around 70% of gastric cancers are H. pylori-positive.
- MALT lymphoma: This is a rare malignant tumour arising from lymphoid tissue associated with the gastric mucosa. 90% of cases are associated with H. pylori infection. The good news is that 70% of early-stage MALT lymphomas can be cured simply by eradicating the bacterium.
- Other diseases: Research has also found a link between H. pylori infection and other non-gastrointestinal conditions, such as iron-deficiency anaemia of unknown cause, idiopathic thrombocytopenic purpura (a condition characterised by a low platelet count), or chronic hives (urticaria).
How is a Helicobacter pylori infection diagnosed?
As the symptoms are non-specific, targeted tests are required to detect the infection. These can be divided into two main groups: invasive (involving a procedure) and non-invasive methods.
Invasive diagnostic procedures
These methods require upper gastrointestinal endoscopy, i.e. gastroscopy (examination of the stomach), during which a tissue sample (biopsy) is taken from the stomach lining. Although many people are apprehensive about the procedure, it is important to know that it can now be carried out very gently, even under general anaesthesia, and that it is the only method which provides a direct view of the condition of the oesophagus, stomach and duodenum. The Endomedix Gastroenterology Centre Its modern equipment and experienced specialists ensure that the examination causes as little discomfort as possible.
The bacterium can be detected in several ways from a sample taken during a gastroscopy:
- Rapid urease test (RUT): The tissue sample is placed in a special gel containing urea. If bacteria are present, the urease enzyme they produce breaks down the urea, causing the gel to change colour. The result can be read within minutes.
- Histopathological examination: The pathologist examines the sample under a microscope and uses special stains (e.g. Giemsa stain) to make the bacteria visible, as well as assessing the extent of inflammation and damage to the mucous membrane.
- Breeding: In the laboratory, attempts are made to culture the bacteria from the tissue sample. This method makes it possible to determine the bacteria’s sensitivity to antibiotics – that is, its resistance – which is essential for selecting the appropriate treatment.
- PCR (polymerase chain reaction): This is a modern molecular biology technique that detects the genetic material (DNA) of bacteria in a sample. Its advantage is that it is extremely sensitive and is also capable of identifying resistance-causing genes (e.g. clarithromycin resistance).
Non-invasive diagnostic procedures
These tests do not require gastroscopy, so they are less invasive for the patient. They are primarily used to confirm a suspected infection and to check the success of treatment (eradication).
- Urea Breath Test (UBT): The most accurate non-invasive method. The patient drinks a special liquid or takes a capsule containing isotope-labelled urea. If H. pylori is present in the stomach, the urease enzyme breaks down the urea, and the labelled carbon atom enters the bloodstream in the form of carbon dioxide, then passes into the lungs, from where it is exhaled. The amount of labelled carbon dioxide measured in the exhaled air is proportional to the activity of the bacteria.
- Stool antigen test (SAT): This test detects a specific protein (antigen) produced by the bacterium in a stool sample. It is a reliable test and is also suitable for monitoring the success of eradication therapy.
- Serological testing: This test detects antibodies produced in response to H. pylori via a blood sample. Its disadvantage is that it does not distinguish between an active and a past infection, as antibodies can remain in the blood for months or even years after successful treatment. It is therefore not suitable for monitoring the success of treatment.
The treatment of Helicobacter pylori in 2025
The aim of treating H. pylori infection is the complete eradication of the bacterium. This is usually achieved using a combination of several medicines, known as combination therapy. Treatment protocols have been significantly influenced in recent years by the spread of antibiotic resistance.
According to the latest clinical guidelines, treatment should be tailored to the resistance patterns characteristic of the geographical region in question. In Hungary, resistance rates for both clarithromycin and metronidazole exceed the critical 15% level. For this reason, a four-drug combination therapy containing bismuth is recommended as the first-line treatment, to be taken for 14 days.
Bismuth-based quadruple therapy (first-line treatment):
- Proton pump inhibitor (PPI) – a medicine that reduces stomach acid (e.g. pantoprazole)
- Bismuth subsalicylate
- Tetracycline (or doxycycline) – an antibiotic
- Metronidazole – an antibiotic
Following unsuccessful treatment, or if bismuth therapy is not an option, second-line (so-called ‘salvage’) treatments may be considered, such as levofloxacin-based combinations. After two unsuccessful treatment attempts, it is advisable to carry out a culture and determine the specific antibiotic resistance.
Important! The success of treatment must be checked in all cases, at the earliest 4 weeks after the end of therapy. The exhaled breath test (UBT) or the faecal antigen test (SAT) are the most suitable for this purpose. Before the follow-up, patients must stop taking proton pump inhibitors (PPIs) for at least 2 weeks and antibiotics for 4 weeks, as these can cause false-negative results.
What does the future hold?
Research is ongoing to develop even more effective and personalised treatments for H. pylori infection. In future, molecular diagnostic methods are expected to play an even greater role; these will enable the bacterium’s resistance profile to be accurately determined before treatment begins, thereby avoiding unnecessary and ineffective courses of antibiotics.
In addition, research is also underway to develop a vaccine against Helicobacter pylori, which could, in the long term, be the most effective means of preventing the infection and the diseases it causes.
When to see a specialist
In summary, Helicobacter pylori is a common pathogen that causes unpleasant digestive symptoms in many people and, in the long term, can lead to serious illnesses, including stomach cancer. Early detection and effective treatment of the infection are key to preventing complications.
If you are experiencing persistent abdominal pain, bloating, nausea or any of the symptoms mentioned above, do not hesitate to seek help! Please feel free to consult a specialist gastroenterologist. A thorough examination, such as the one provided by the Endomedix Gastroenterology Centre It can also help to identify the real cause of your symptoms and get you started on the right, personalised treatment. Remember: your health is the most important thing, and an early diagnosis can save lives!
