H. pylori Infection Diagnosis & Treatment

H. pylori Infection Diagnosis & Treatment

Published on Friday, November 04, 2022 by Haley McGaha

Most people refer to Helicobacter pylori as H. pylori, which is a type of bacteria that infects your stomach. 

It is passed from person to person through contact with saliva, vomit, or stool.

It may also be spread through contaminated foods or water.

What are the symptoms of H. pylori?

Many people with H. pylori do not have signs and symptoms. 

When signs and symptoms do occur, you may feel:

  • stomach pain that worsens when your stomach is empty
  • an ache or burning in your stomach
  • nausea
  • loss of appetite
  • weight loss
  • bloating
  • frequent burping

How do I know that I have H. pylori?

There are various diagnostic tests, which can be categorized as invasive and noninvasive tests

Invasive tests can determine H. pylori during endoscopy by 1 of 3 methods: biopsy urease test, histology, and bacterial culture. 

Noninvasive tests include urea breath testing (UBT), stool antigen testing, and serology. UBT and stool antigen are tests of active infection. Serology can be positive in patients with an active or prior infection.

What should I do before getting tested for H. pylori?

Before testing, certain medications should be held as they can interfere with test results and decrease the sensitivity of the results. When undergoing endoscopic-based tests, PPIs (proton pump inhibitors) should be stopped within 1-2 weeks and bismuth/antibiotic use should be stopped within 4 weeks of testing.

With urea breath tests and stool antigen tests, you do not have to stop PPI therapy 1-2 weeks before testing. In the case you do not stop PPI therapy 1-2 weeks before testing, it is best to assume a positive result is a true positive. If you get a negative test result, it may represent a false negative and should be confirmed with repeat testing after stopping PPI therapy for 1-2 weeks.

If I do have H. pylori, what is recommended for treating it?

Generally, treatment options include antibiotics and PPIs for short-term use. Specific antibiotic use will be determined by your physician based on local antibiotic resistance patterns, previous exposure, and allergies to certain antibiotics.

If my H. pylori go untreated, what are some complications that I may get?

Some complications can include ulcers, inflammation of the stomach lining, as well as an increased risk of mucosa-associated lymphoid tissue lymphoma and stomach cancer.

Is there a way to confirm that my H. pylori is gone?

Confirmation that your H. pylori infection is gone is important because of increasing antibiotic resistance. Tests to use are endoscopy, urea breath test, and stool antigen testing. You would not want to use serology testing as those tests are known to show not only active H. pylori infections, but also prior infections. Make sure you are waiting 1-2 weeks after stopping PPIs and 4 weeks after antibiotic use to confirm that your H. pylori is gone.

While researching treatment options, I found it shocking that approximately 20% of patients fail an initial attempt to eliminate H. pylori (much of this due to antibiotic resistance). Therefore, confirming that H. pylori are gone through follow-up care is important.


  1. Mayo Foundation for Medical Education and Research. (2022, May 5). Helicobacter pylori (H. pylori) infection. Mayo Clinic. Retrieved October 18, 2022, from https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171
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  3. U.S. National Library of Medicine. (n.d.). Proton Pump inhibitors: Medlineplus medical encyclopedia. MedlinePlus. Retrieved October 24, 2022, from https://medlineplus.gov/ency/patientinstructions/000381.htm 
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  5. Cortés, P., Nelson, A. D., Bi, Y., Stancampiano, F. F., Murray, L. P., Pujalte, G., Gomez, V., & Harris, D. M. (2021). Treatment Approach of Refractory Helicobacter pylori Infection: A Comprehensive Review. Journal of primary care & community health, 12, 21501327211014087. https://doi.org/10.1177/21501327211014087 
  6. Lamont, J. T. (n.d.). Treatment regimens for Helicobacter pylori in adults. UpToDate. Retrieved October 18, 2022, from https://www.uptodate.com/contents/treatment-regimens-for-helicobacter-pylori-in-adults 

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