Risks of an Untreated H. pylori Infection

H. pylori (Helicobacter pylori) is a type of bacteria that causes a stomach infection. It is a very common infection. Most people get infected with Helicobacter pylori bacteria during childhood. Indeed, it is estimated that more than half the world’s population has H. pylori. But most people don't realize they have this infection because they never get any symptoms from it. Some people, however, can get sick with gastritis (stomach inflammation) or peptic ulcer disease (stomach ulcers). If symptoms are present and a doctor diagnoses Helicobacter pylori, it can be treated with certain medicines.

Please continue reading to learn more about Helicobacter pylori infection, including its symptoms, how it spreads, and how it is diagnosed and treated. We will also talk about the risks of leaving it untreated and what you can do to prevent H. pylori infection.

What is Helicobacter pylori infection?

As mentioned, Helicobacter pylori is a bacteria that infects the stomach and duodenum (start of the small intestine). The infection usually occurs in children, but only 1 in 5 people with Helicobacter pylori infection develop any symptoms.

In some people, the bacteria can irritate the stomach’s mucous lining and cause symptoms of H. pylori gastritis and peptic ulcers. In fact, H. pylori is the most common cause of stomach ulcers. If H. pylori symptoms are present, a healthcare provider can treat them with a combination of medications, including antibiotics and proton pump inhibitors (acid-reducing medications).

Who is at risk of getting H. pylori?

Experts estimate that 50-75% of people in the world have H. pylori. The infection usually occurs during childhood. Most people do not develop an illness.

H. pylori infections are more common in parts of the world where people do not have access to clean drinking water. They are more prevalent among people in developing nations where living conditions are crowded with poor sanitary facilities, leading to increased chances of eating contaminated food.

In the United States, in children under age 10, about 5% have Helicobacter pylori infections.

How is H. pylori transmitted?

H. pylori can be transmitted among people. The bacteria are present in saliva, teeth plaque, and stool. The infection can spread if a person does not wash their hands thoroughly after using the bathroom. The bacteria can also be transferred by kissing and by consuming contaminated food and water.

How bad can H. pylori get?

Most people with H. pylori infections don’t have symptoms. About 20% of people develop signs and symptoms of inflammation in the digestive tract, stomach ulcers, and duodenal ulcers.

The most common symptom of H. pylori infection is a dull or burning pain in the abdomen that often occurs after meals. In some people, the stomach pain is worse on an empty stomach. The abdominal pain can wax and wane, lasting for several hours.

Besides belly pain, other symptoms of Helicobacter pylori infection include bloating, indigestion, frequent burping, nausea, vomiting with bloody vomit (looks like coffee grounds), poor appetite, unintended weight loss, and dark stools.

How do doctors diagnose H. pylori?

If your doctor suspects you might have Helicobacter pylori infection based on your symptoms and physical exam, they may ask for some tests, such as:

Breath Tests

A breath test involves breathing out into a test bag, drinking a test solution, and exhaling into the test bag again. This measures how much carbon dioxide is released in the breath. In people with H. pylori infection, there is more carbon dioxide in the breath after they drink the test solution.

Stool Tests

A polymerase chain reaction (PCR) stool test can be done to detect H. pylori bacteria in the stool.

Upper Endoscopy

Doctors can perform a minimally-invasive imaging study called an upper endoscopy. This involves inserting a thin, flexible tube through the mouth into the belly. The tube has a camera that allows doctors to see the stomach lining. A small sample of the stomach’s lining can be taken and tested in the laboratory to check for H. pylori.

How do doctors treat H. pylori?

Those who have a diagnosis of H. pylori infection are usually treated with multiple medications, including antibiotics and proton pump inhibitors (acid reducers). This is because H. pylori infections can be hard to treat. One medicine cannot cure the infection. The treatment for H. pylori infection usually lasts 14 days.

Doctors typically prescribe two antibiotics to clear the infection. Common choices of antibiotics include amoxicillin, tetracycline, clarithromycin (Biaxin), and metronidazole (Flagyl). In addition, doctors prescribe proton pump inhibitors such as pantoprazole (Protonix), omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), and rabeprazole (Aciphex). A drug called bismuth subsalicylate (Pepto-Bismol) may also be included in the treatment regimen to protect the stomach cells.

For the sake of convenience (to avoid taking a large number of pills every day), a relatively new pill called Talicia has been developed. It is a capsule that contains two antibiotics (amoxicillin and rifabutin) plus omeprazole. Other treatments like Tritec (bismuth plus a stomach acid reducer) or Helidac (bismuth plus two antibiotics) are also available. Your doctor can help you decide on the best medicine for H. pylori infection.

Does H. pylori go away without treatment?

There have been some reports that in a small number of people H. pylori may disappear and reappear in the stomach lining without a specific antibiotic regimen. However, the natural history of H. pylori infections is not completely understood. The only way to cure H. pylori is by taking the medicines your doctor prescribes.

What will happen if H. pylori goes untreated?

Because treatment of Helicobacter pylori infections requires taking so many medications, it can cause side effects. These side effects are usually minor and go away in a few days. If you stop taking the medications because of side effects or forget to take some of the medicines, your H. pylori infection will not be cured. This may cause worsening symptoms in the future, including peptic ulcers.

You should tell your doctor if you have side effects from H. pylori medicines. Your doctor may give you different medicines or give you something to make the side effects better.

What happens if you have H. pylori for years?

Antibiotic treatment can clear the infection and protect the stomach lining. But if you leave H. pylori infection untreated, it can lead to serious complications, including:

Gastritis and Peptic Ulcer Disease

The H. pylori bacteria can multiply in the stomach lining over the years. To survive in the acidic environment of the stomach, the bacteria secrete an enzyme called urease. This enzyme converts urea to ammonia, and the ammonia protects H. pylori from stomach acids. This allows H. pylori to multiply and destroy the stomach tissue. Over time, this can lead to gastritis and/or gastric ulcer. If you have symptoms of H. pylori infection, you should avoid taking nonsteroidal anti-inflammatory drugs. These medicines can increase the risk of developing a stomach ulcer or duodenal ulcer, which can cause internal bleeding in the abdominal cavity.

Stomach Cancer

People who have Helicobacter pylori are at an increased risk of developing stomach cancer later in life. According to the National Cancer Institute, the risk that a person will develop stomach cancer can be nearly 6 times higher in infected people compared to healthy people. The risk of stomach cancer is higher in individuals who have a strong family history of stomach cancer or other risk factors for cancer. If this is the case, healthcare providers may recommend getting tested for H. pylori antibodies and/or coming in for regular checkups.

How can I prevent H. pylori infection?

You can lower your risk of Helicobacter pylori infection by ensuring you drink clean water and use clean water during food preparation. You should also make sure you wash your hands thoroughly with soap and water for at least 20 seconds after using the toilet.

Is there a vaccine for H. pylori?

Despite the large number of people who get H. pylori infections, an H. pylori vaccine has not been a priority for Big Pharma. There is, however, one vaccine to prevent H. pylori under development that has shown promising early results. Children who got this vaccine during trials were protected against H. pylori infection for up to 3 years.

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