> **Healthylife** — Healthylife Pharmacy | Your online health destination > [Products](https://www.healthylife.com.au/browse) · [Health Hub](https://www.healthylife.com.au/learn) > > --- # Treatment of Helicobacter pylori Infection Healthylife Pharmacy14 December 2015·4 min read Spread the word [](https://x.com/share?url=https://www.healthylife.com.au/learn/treatment-of-helicobacter-pylori-infection "x sharing")[](https://www.facebook.com/sharer/sharer.php?u=https://www.healthylife.com.au/learn/treatment-of-helicobacter-pylori-infection "facebook sharing")[]( "email sharing") [Add us as a preferred source](https://google.com/preferences/source?q=Healthylife.com.au) ### Jump to Helicobacter pylori (_H. pylori_) is a spiral-shaped bacterium that is found in the mucous layer lining of the inner surface of the stomach or first part of the small intestine (“helico-,” means “spiral”). _H. pylori_ is the main cause of ulcers occurring in the lining of the upper part of the small intestine (duodenal ulcers) and in the lining of the stomach (gastric ulcers). Initially, the bacterium causes inflammation (gastritis or duodenitis). Many people may be unaware of this inflammation, and only experience symptoms when an ulcer develops, perhaps years later. Not all people infected with _H. pylori_ will develop an ulcer. Currently, about half of the world’s population is infected by _H. pylori,_ with rates in the developed world in the order of 70%. _H. pylori_ may be detected in approximately 90% of individuals with peptic ulcer disease; however, less than 15% of infected persons may have peptic ulcer disease. ## Illnesses associated with _H. pylori_  The presence of _H. pylori_ in the stomach or small intestine is usually asymptomatic. However, duodenal or gastric ulcers are reported to develop in 1 to 10% of infected patients. In 20% of cases, the infection may progress to pre-cancerous changes in the stomach and eventually to gastric cancer in 2% of those persons infected with the organism. Gastric lymphoma is an even rarer consequence of _H. pylori_ infection, occurring in fewer than 1% of those who are infected. ## Symptoms of a Peptic Ulcer? The most common ulcer symptom is gnawing or burning pain in the epigastrium (the upper middle region of the abdomen). This pain typically occurs when the stomach is empty, between meals and in the early morning hours, but it can also occur at other times. It may last from minutes to hours and may be relieved by eating or by taking antacids. Less common ulcer symptoms include nausea, vomiting, and loss of appetite. Bleeding can also occur; prolonged bleeding may cause anemia leading to weakness and fatigue. If bleeding is heavy, bloody vomiting or bloody stools may occur. ## How Is _H. pylori_ Infection Acquired? The most common route of _H. pylori_ infection is either oral-to-oral (stomach contents are transmitted from mouth to mouth) or fecal-to-oral (from stool to mouth) contact. Parents and siblings seem to play a primary role in  transmission. However, it is thought that people infected with the bacterium are only capable of passing it to others for a short period (days or weeks). It may be passed via the fingers through contact with vomit or stools from an infected person. Therefore, good hygiene may decrease the risk of the bacterium being spread. However, it is thought that people living in the U.S. are unlikely to pass it on and do not need to take any special measures to avoid giving it to others. ## Diagnosing _H. pylori_ Infection ### Endoscopy The test usually used to diagnose an ulcer is an endoscopy. This is a procedure where a flexible fiber-optic tube, which relays images to a video camera, is passed through the mouth down into the stomach. The oesophagus, stomach, and duodenum can be inspected in this manner and a biopsy can be obtained. ### Noninvasive tests  Noninvasive tests are divided into the urea breath test (UBT), serology and stool antigen test (SAT). **Breath test.** For the urea breath test, patients swallow urea labelled with an uncommon isotope, either radioactive carbon-14 or non-radioactive carbon-13. In the subsequent 10–30 minutes, the detection of isotope-labelled carbon dioxide in exhaled breath indicates that the urea was split; this indicates that urease (the enzyme that _H. pylori_ uses to metabolize urea) is present in the stomach, and hence that _H. pylori_ bacteria are present. Urea is an organic chemical compound, and is essentially the waste produced by the body after metabolising protein. **Serological tests** detect the presence of antibodies to _H. pylori._ Positive serology indicates current or past infection with _H. pylori._ **A stool antigen test** checks to see if substances that trigger the immune system to fight an _H. pylori_ infection are present in the stool. ## Treating _H. pylori_ Infection  ### Triple therapy Standard treatment of an _H. pylori_ infection consists of 3 drugs, the so-called ‘triple therapy’ plan which includes a proton pump inhibitor (PPI) (suppresses gastric acid) _and_ two different antibiotics.  ### Sequential therapy Standard triple therapy started from eradication rates of more than 90%, and has now decreased to 70–80%. Treatment of _H. pylori_ infection is challenged by a dramatic fall in eradication rates all over the world. Over the past few decades, the efficacy of the standard first-line triple therapy has experienced a steady decline. There are several reasons for the loss of eradication efficacy, but the far most important is the increasing rate of _H. pylori_ resistance to antibiotics. Newer treatment regimens have been introduced including sequential, quadruple therapies. In sequential therapy for _H. pylori_, more antibiotics are added to the treatment regimen in sequence rather than giving all 4 drugs together. Sequential therapy is considered superior to standard triple therapy based on 2 systematic reviews. The confirmation of cure should be performed by noninvasive tests, except in cases when a follow-up endoscopy is indicated from a clinical perspective (gastric ulcer, preneoplastic lesions, lymphoma). As a noninvasive test, the UBT should be employed, if available. #### References 1. Helicobacter Pylori Infection Patient Fact Sheets. _Monthly Prescribing Reference._ [http://www.empr.com/helicobacter-pylori-infection-patient-fact-sheets/article/220646_/_](http://www.empr.com/helicobacter-pylori-infection-patient-fact-sheets/article/220646/) Updated May 2013. Accessed 1 Dec 2014. 2. Suerbaum S, Michetti P. _Helicobacter pylori_ _N Engl J Med._ 2002;347:1175–1186. 3. Santacroce L. Helicobacter Pylori Infection Treatment & Management. [http://emedicine.medscape.com/article/176938-treatment](http://emedicine.medscape.com/article/176938-treatment) Updated 14 Sept 2014. Accessed 1 Dec 2014. 4. Barclay L. Diagnosis and Management of H pylori Infection. [http://www.medscape.com/viewarticle/720935](http://www.medscape.com/viewarticle/720935) 28 Apr 2010. Accessed 1 Dec 2014. 5. Peek RM, Jr, Blaser MJ. _Helicobacter pylori_ and gastrointestinal tract adenocarcinomas. Nat Rev Cancer. 2002;2:28–37. 6. Sung Soo Kim, SS, Ruiz, VE, Carroll, JD, et al. _Helicobacter pylori_ in the pathogenesis of gastric cancer and gastric lymphoma. _Cancer Lett._ 28 Jun 2011; 305(2): 228–238. 7. O'Connor A, Molina-Infante J, Gisbert JP, O'Morain C. Treatment of Helicobacter pylori infection 2013. _Helicobacter_. Sep 2013;18 Suppl 1:58-65. 8. Joseph Adrian Lumawig Buensalido, Pranatharthi Haran Chandrasekar. Helicobacter pylori Infection Treatment. [http://emedicine.medscape.com/article/2172395-overview](http://emedicine.medscape.com/article/2172395-overview) Updated 8 Aug 2014. Accessed 1 Dec 2014. 9. Paoluzi OA, Visconti E, Andrei F, et al. Ten and eight-day sequential therapy in comparison to standard triple therapy for eradicating _Helicobacter pylori_infection: a randomized controlled study on efficacy and tolerability. _J Clin Gastroenterol_ 2010; 44:261–266. 10. Kearney DJ, Brousal A. Treatment of _Helicobacter pylori_infection in clinical practice in the United States: results from 224 patients. _Dig Dis Sci_ 2000; 45:265–271. 11. Marshall B. Sequential Therapy for _Helicobacter pylori_: A Worthwhile Effort for Your Patients. _Ann Intern Med._ 2008;148(12):962-963. 12. Vaira D et al. Sequential therapy versus standard triple-drug therapy for _Helicobacter pylori_ eradication: A randomized trial. _Ann Intern Med_ 2007 Apr 17; 146:556-63. 13. Zullo A, De Francesco V, Hassan C, et al. Modified sequential therapy regimens for Helicobacter pylori eradication: a systematic review. _Dig Liver Dis_. Jan 2013;45(1):18-22. 14. Zullo A, Hassan C, Ridola L, De Francesco V, Vaira D. Standard triple and sequential therapies for Helicobacter pylori eradication: an update. _Eur J Intern Med_. Jan 2013;24(1):16-9. 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