Helicobacter pylori is a bacterium that is present in many people’s bodies without causing any symptoms. However, in certain cases, it can be responsible for serious digestive disorders, such as gastritis, peptic ulcers and even stomach cancer. The symptoms are often non-specific, so they can be difficult to recognise. In this article, we explain in detail what signs to look out for, what lies behind the infection, and how it can be treated effectively.
What exactly is Helicobacter pylori?
Helicobacter pylori (H. pylori for short) is a spiral-shaped, Gram-negative bacterium that colonises the stomach lining. What makes it unique is its ability to survive the stomach’s extremely acidic environment. It achieves this with the help of an enzyme it produces, called urease, which breaks down urea into ammonia and carbon dioxide. The ammonia neutralises the stomach acid in the bacterium’s immediate surroundings, thereby ensuring its survival.
The infection is extremely widespread worldwide, affecting more than half the population, and its prevalence increases with age. Although the majority of those infected – around 80% – remain completely asymptomatic, the bacterium causes chronic inflammation (gastritis) of the stomach lining. It is this inflammatory condition that can lead to various complications in the long term.
What symptoms might indicate a Helicobacter pylori infection?
The symptoms associated with H. pylori infection are varied and often non-specific, meaning they may also indicate other digestive problems. For this reason, it is important to consult a specialist, such as a Endomedix Gastroenterology Centre Please consult a specialist.
The most common symptoms are:
- Dyspepsia: This is an umbrella term that encompasses a range of unpleasant sensations experienced in the upper abdomen. It includes stomach pain, a burning sensation, bloating, feeling full too soon (when we feel full even after eating only a small amount of food), and frequent belching. Dyspepsia is the most common symptom of peptic ulcer disease.
- Abdominal pain: Typically, a dull, burning pain beneath the breastbone, which may ease or intensify after a meal.
- Nausea and vomiting: Although less common, they can occur, particularly in cases of more severe gastritis.
- Loss of appetite and weight loss: Chronic inflammation and unpleasant symptoms can reduce your appetite, which may lead to unintentional weight loss in the long term.
It is important to note that a significant proportion of those infected do not experience any symptoms. The onset and severity of symptoms also depend on the complications caused by the inflammation.
Medical explanation: How does H. pylori cause disease?
Once the bacterium has colonised the stomach, it triggers a chronic inflammatory process (known as type B chronic gastritis). The course of the disease and the complications that develop depend on which part of the stomach is most affected by the inflammation.
Peptic ulcer disease (Ulcus pepticum)
H. pylori infection is the most common cause of peptic ulcer disease. The bacterium is detectable in 90% of cases of duodenal ulcer (ulcus duodeni) and in 70–90% of cases of gastric ulcer (ulcus ventriculi).
- Duodenal ulcer: If the inflammation mainly affects the lower part of the stomach, the antrum, it leads to increased acid production. When this increased acid load reaches the duodenum, it damages its mucous membrane and leads to the formation of ulcers. H. pylori does not colonise the healthy duodenal mucosa directly, but only those areas where cells similar to those of the gastric mucosa (gastric metaplasia) appear as a result of chronic acid exposure.
- Stomach ulcer: When the inflammation affects the body (corpus) of the stomach, it can lead to the destruction of acid-producing cells – that is, reduced acid production (hypoacidity) – and thinning of the mucous membrane (atrophy). This weakened mucous membrane becomes prone to ulcer formation.
Certain strains of the bacterium are more virulent, meaning they are more likely to cause a more severe illness. Examples include strains carrying the _cagA_ and _vacA_ genes, which trigger a more severe inflammatory response and produce cytotoxins (cell poisons).
Stomach cancer (Carcinoma ventriculi)
In 1994, the World Health Organisation (WHO) classified H. pylori as a Group I carcinogen (cancer-causing agent). Infection increases the risk of developing stomach cancer by a factor of 3 to 6. Around 70% of stomach cancers are H. pylori-positive.
The path leading to the development of cancer is a multi-stage process known as the Correa cascade:
- Chronic inflammation (gastritis)
- Atrophy of the mucous membrane
- Intestinal metaplasia (the gastric mucosa is replaced by cells characteristic of the intestinal mucosa)
- Dysplasia (pre-cancerous condition)
- Carcinoma (malignant tumour)
This process can take decades. It is important to note that the successful eradication of the bacteria can halt or slow down this process, thereby reducing the risk of cancer.
MALT lymphoma
MALT lymphoma is a low-grade (less aggressive) lymphoma that arises from the lymphoid tissue associated with the gastric mucosa. 90% of cases are linked to H. pylori infection. The constant immune stimulation caused by the bacterium leads to the uncontrolled proliferation of lymphocytes (a type of white blood cell). The good news is that, in the early stages of the disease, successful eradication of H. pylori results in complete regression of the lymphoma in 70% of cases.
How is the infection diagnosed?
As the symptoms are not clear-cut, an accurate diagnosis is essential if an infection is suspected. The Endomedix Gastroenterology Centre uses modern diagnostic methods to detect H. pylori.
Diagnostic methods can be divided into two main groups:
1. Non-invasive tests (which do not require gastroscopy):
- Urea breath test: This is the most reliable non-invasive method. The patient ingests a liquid or capsule containing urea. If H. pylori is present in the stomach, its urease enzyme breaks down the urea, and in the process carbon dioxide is produced, which can be detected in the exhaled air.
- Stool antigen test: This method detects the bacterial antigen (a specific protein) in a stool sample. Its reliability is similar to that of the breath test.
- Serological test (blood test): Antibodies produced by the body in response to the bacterium can be detected in the blood. This test only shows whether the body has been exposed to the infection; it cannot distinguish between an active infection and one that has already run its course. For this reason, it is not suitable for monitoring the success of treatment.
2. Invasive tests (during gastroscopy):
- Gastroscopy (gastroscopy): If the symptoms (e.g. suspected ulcer, upper gastrointestinal haemorrhage) warrant it, a gastroscopy is required. During this procedure, the specialist uses a flexible instrument (an endoscope) to examine the oesophagus, the stomach and the upper part of the duodenum directly.
- Histopathological examination: During the endoscopy, a small tissue sample (biopsy) is taken from the lining of the stomach and examined under a microscope. This allows not only the presence of the bacterium to be detected, but also the extent of inflammation, atrophy or precancerous conditions.
- Urease rapid test: The tissue sample is placed in a medium containing a special reagent. The urease activity of the bacteria causes a colour change, indicating the presence of an infection.
Tips and treatment options
H. pylori infection is treated with a combination of antibiotics and acid-reducing medicines. This treatment eradication treatment is called.
Eradication therapy
The basic principle of treatment is to select a combination of medicines that eradicates the bacteria with an efficacy of at least 80%. In Hungary, the rate of resistance to the antibiotics clarithromycin and metronidazole is high (exceeding 15%); therefore, the so-called bismuth-based quadruple therapy recommended.
This 14-day programme includes the following:
- Proton pump inhibitor (PPI) acid-reducing medication (e.g. pantoprazole) – twice daily
- Bismuth subsalicylate – four times a day
- Tetracycline antibiotic – four times a day
- Metronidazole antibiotic – three times a day
If resistance cannot be confirmed, or if the four-drug regimen cannot be used, a clarithromycin-based triple combination may also be considered.
What to do after treatment
After the end of the treatment must be checked its success! The follow-up test (urea breath test or faecal antigen test) can be carried out no earlier than 4 weeks after the end of the course of treatment. It is important that you do not take any acid-reducing medication (PPIs) for at least 2 weeks before the follow-up test, and no antibiotics for 4 weeks, as these can cause false-negative results.
If the first course of treatment is unsuccessful, so-called „salvage” therapy is required, which involves a different type of antibiotic. After two unsuccessful treatment attempts, you must consult a gastroenterologist, who will select the appropriate, targeted treatment based on culture and resistance testing.
What else can we do to aid recovery?
- Follow your doctor’s instructions carefully! You must complete the full course of antibiotics, even if your symptoms have already improved.
- Avoid substances that irritate the stomach lining! Smoking, excessive alcohol consumption and taking non-steroidal anti-inflammatory drugs (NSAIDs) can worsen the condition of the stomach and hinder recovery.
- Etrend: Although there is no specific „Helicobacter diet”, a balanced, fibre-rich diet packed with vegetables and fruit supports the health of the digestive system. Avoid overly spicy, fatty or heavy foods if they cause you discomfort.
When should we see a doctor?
If you experience any of the symptoms mentioned above, particularly if they are persistent, you should definitely consult your GP or a gastroenterologist. The Endomedix Gastroenterology Centre Our experienced doctors are on hand to help establish an accurate diagnosis and initiate the appropriate treatment.
A medical examination is particularly important if „alarming” symptoms appear:
- Vomiting blood or coffee-ground-like vomit
- Black, tar-like stools (indicating digested blood)
- Difficulty swallowing
- Significant, unintentional weight loss
- There has been a history of stomach cancer in the family
Summary: The key to recovery is an accurate diagnosis
Helicobacter pylori infection is a treatable condition, and its detection is crucial in preventing more serious complications, such as peptic ulcer disease or stomach cancer. Thanks to modern diagnostic procedures and effective eradication therapies, the bacterium can be successfully eliminated from the body. If you have digestive problems, do not hesitate to seek help! Early diagnosis and professional treatment are the key to long-term health.
