Overview
Helicobacter pylori (H. pylori) is a bacterium that lives in the lining of the stomach. It affects about half of the world's population, and the prevalence is around 70% in our country. It usually infects in childhood and can remain in the stomach for life.
Most infected people have no symptoms; however, in some people it can lead to gastritis, stomach ulcers, duodenal ulcers, and stomach cancer.
Symptoms
Most infected people do not experience symptoms. If symptoms develop:
- Burning, pain in the upper stomach (especially on an empty stomach)
- Nausea
- Loss of appetite
- Frequent belching
- Bloating
- Unexplained weight loss
- If ulcer is present: pain waking you at night, pain relieved or worsened by eating
- In serious cases: bloody or coffee-ground-like vomiting, black stools
Causes and Transmission
The exact route of transmission is not fully known. Possible routes:
- Mouth-to-mouth (kissing, shared utensils, drinking glasses)
- Fecal-to-oral (poor hand hygiene)
- Contaminated water and food
- Family transmission is very common
Risk Factors
- Living in crowded environments during childhood
- Inadequate hygiene conditions
- Limited access to clean water
- Living with infected family members
- Being born/living in developing countries
Complications
- Peptic ulcer (stomach or duodenal ulcer)
- Stomach inflammation (chronic gastritis)
- Stomach cancer (long-term, 1-2% risk)
- MALT lymphoma (a rare gastric lymphoma)
- Iron deficiency anemia
- Vitamin B12 deficiency
When to See a Doctor
- Persistent stomach pain or burning
- Frequently recurring stomach complaints
- Family history of stomach cancer
- If you have been previously diagnosed with an ulcer
- If you are taking NSAIDs
- Bloody vomit, black stools
- Unexplained weight loss
Diagnosis and Treatment
Diagnostic tests:
- Urea breath test (most sensitive, easy)
- Stool H. pylori antigen test
- Blood test (antibody; also positive for past infection)
- Endoscopic biopsy (definitive diagnosis + ulcer evaluation)
Before testing, PPIs should be stopped for 2 weeks and antibiotics for 4 weeks.
Treatment:
Usually a 14-day triple or quadruple antibiotic therapy:
Triple therapy:
- PPI (omeprazole, pantoprazole) +
- Clarithromycin +
- Amoxicillin (metronidazole in case of penicillin allergy)
Quadruple therapy (in regions with clarithromycin resistance):
- PPI +
- Bismuth subcitrate +
- Tetracycline +
- Metronidazole
Post-treatment check:
Success is checked 4-6 weeks after treatment with a urea breath test or stool antigen test.
Prevention
- Wash your hands often and properly (especially after the toilet, before meals)
- Drink clean water
- Do not eat unwashed fruits and vegetables
- Do not consume raw or undercooked meat
- Clean shared utensils (forks, glasses) well
- If one family member is diagnosed, others should also be evaluated
- Pay attention to children's hygiene