H. Pylori Infection

What is an H. pylori infection?

H. pylori (Helicobacter pylori) is a type of bacteria that infects your stomach. It’s the most common chronic bacterial infection in humans. It affects more than half of the world’s population. But it doesn’t cause illness in most people.

Helicobacter pylori (pronounced “hel-i-ko-bak-ter pai-law-rai”) infections mostly occur during childhood. It’s more common in developing countries. In the U.S., about 5% of children under the age of 10 have H. pylori bacteria. Infection is most likely to occur in children who live in crowded conditions and areas with poor sanitation.

What happens if you have H. pylori?

H. pylori bacteria are spiral-shaped and can live in the harsh acidic environment of your stomach by producing enzymes that neutralize the acid. This allows H. pylori to burrow into your stomach lining, where they can cause chronic inflammation and irritation. They can lead to:

• Peptic ulcers. These are painful sores that can develop in the lining of your stomach or duodenum (the first part of your small intestine).
• Gastritis. This is inflammation of your stomach lining.
• Stomach cancer. H. pylori infection is a risk factor for stomach cancer. But most people with H. pylori won’t develop it.

H. pylori symptoms

Most children with H. pylori infection don’t have symptoms. Only about 5% to 10% do. If they do, symptoms and signs arise from peptic ulcers or gastritis.

One symptom they may experience is a dull or burning pain in their stomachs. More often, this happens a few hours after eating and at night. Their pain may last minutes to hours and may come and go over several days to weeks.

Other H. pylori symptoms may include:

• Unexplained weight loss
• Bloating
• Nausea and vomiting (bloody vomit)
• Indigestion
• Burping
• Loss of appetite
• Feeling full after eating a small amount of food (early satiety)

What does H. pylori poop look like?

In most people with H. pylori infection, their poop will appear normal. This is because many people experience no symptoms or only mild ones. But there’s a warning sign to look for in your poop that can be a point to a more serious complication: blood.

If your poop appears dark, black or tarry, this could mean you have bleeding in your upper digestive tract, possibly due to an ulcer from H. pylori. Blood in your poop that appears red can be a sign of bleeding lower in your digestive system.

If you notice any signs of blood in your poop, it’s important to see a healthcare provider right away. They can determine the cause of the bleeding and recommend the appropriate treatment.

H. pylori causes

The most common cause of H. pylori infection is direct person-to-person transmission. H. pylori causes include:

• Close contact. This includes sharing utensils or having contact with vomit or poop from an infected person.
• Contaminated food or water. H. pylori can survive in unsanitary conditions. They might be present on food or in water that hasn’t been properly cleaned or treated.

Is H. pylori contagious?

Yes. H. pylori can spread from person to person. H. pylori are found in saliva, poop and plaque on teeth. Infection can spread by transferring the bacteria from the hands of those who haven’t thoroughly washed them after pooping.

Risk factors for H. pylori infection

Crowded living conditions and areas with poor sanitation are major risk factors for H. pylori infection, especially in developing countries. While contaminated food and water can be a cause, person-to-person transmission is likely more common.

Complications of H. pylori infection

If you have an H. pylori infection, you have an increased risk of stomach cancer later in life. If you have a strong biological family history of stomach cancer and other cancer risk factors, your healthcare provider may recommend being tested for H. pylori antibodies. They may suggest this even if you don’t have symptoms of a stomach ulcer.

In addition to screening and treatment, your provider may suggest some lifestyle changes. This may mean including more fruits, vegetables and fiber in what you eat. Regular checkups with your provider and following their recommendations can reduce your cancer risk.

How doctors diagnose H. pylori infection

If your healthcare provider suspects H. pylori bacteria may be causing a stomach ulcer, they may order one or more of the following H. pylori tests:

• Breath test
• Blood test
• Stool (poop) test
• Upper endoscopy

How do you treat Helicobacter pylori?

If you don’t have Helicobacter pylori bacteria symptoms, you don’t need treatment. If your provider diagnosed you with H. pylori, avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines can increase your risk of developing an ulcer.

If you do have symptoms of peptic ulcers or gastritis, H. pylori treatment includes a combination of antibiotics and an acid-reducing proton pump inhibitor (PPI).

• Antibiotics. Your provider will usually prescribe two antibiotics. Among the common choices are amoxicillin, clarithromycin (Biaxin^®), metronidazole (Flagyl^®) and tetracycline.
• Proton pump inhibitor. Commonly used proton pump inhibitors include lansoprazole (Prevacid^®), omeprazole (Prilosec^®), pantoprazole (Protonix^®), rabeprazole (Aciphex^®) and esomeprazole (Nexium^®).
• Bismuth subsalicylate. Sometimes, your provider may add this medication (Pepto-Bismol^®) to your treatment. It protects your stomach lining.

You’ll usually take a combination of Helicobacter pylori treatments for 14 days.

One newer medication, Talicia^®, combines two antibiotics (rifabutin and amoxicillin) with a proton pump inhibitor (omeprazole) into a single capsule.

What foods should I avoid if I have an H. pylori infection?

Certain foods can irritate your stomach lining or slow digestion if you have H. pylori. You may want to avoid:

• Spicy foods. Chili peppers, mustard and anything with a strong kick can aggravate inflammation.
• Acidic foods. Citrus fruits like lemons, oranges and grapefruits might increase stomach acid and discomfort.
• Fatty foods. Fatty meats, fried foods and processed cheeses slow down digestion and keep food in your stomach longer, potentially worsening symptoms.
• Caffeinated drinks. Coffee, black tea and sodas can stimulate stomach acid production.
• Alcohol. Alcohol irritates the stomach lining and can hinder healing.
• Processed foods. These are often loaded with preservatives and additives that may irritate your stomach.

It’s important to note that everyone reacts differently. If you have specific foods that trigger heartburn or indigestion, avoid those, as well.

When should I see my healthcare provider?

See your healthcare provider if you develop symptoms of peptic ulcers or gastritis. It’s also important to see them if you have any signs of bleeding in your upper digestive tract, like vomiting blood or blood in your poop.

If you have a strong family history of stomach cancer, your provider may recommend getting tested and treated for H. pylori to potentially reduce your long-term risk.

Also, if you’ve finished treatment but are still experiencing symptoms, see your provider. They may need to retest you for H. pylori to confirm it’s gone and explore other potential causes for your symptoms.

Can H. pylori infection be prevented?

You can lower your risk of H. pylori infection if you:

• Drink clean water and use clean water during food preparation. (This is especially important if you live in areas of the world known to have a contaminated water supply.)
• Wash your hands thoroughly (20 seconds) with soap and water before eating and after using the bathroom.

What’s my child’s prognosis (outcome) if they have an H. pylori infection?

Your child needs to follow the treatment plan. This means they have to finish all their medications. If they do, the chance that an infection would return within three years is less than 10%. Also, treatment may heal stomach ulcers. But it can take weeks to months for symptoms to completely go away.

How will I know if the H. pylori infection has healed?

Your healthcare provider will repeat a breath and/or stool test. They’ll wait to test until at least two weeks after completion of proton pump inhibitor treatment. They’ll wait four weeks after your child completes antibiotic treatment.