Gastrointestinal | H. pylori

Helicobacter pylori  frequently infects the gastrointestinal tract, and is in most areas of the world. H. pylori  occurs in 90 percent of patients with duodenal ulcers and in 70 to 90 percent of patients with gastric ulcers.

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H. pylori  is a Gram-negative, microaerophilic, spherical bacteria that often resides in the mucous layer of the antral and fundal gastric epithelium, and occasionally in ectopic gastric tissue in the duodenum or esophagus. First isolated from humans in 1982, H. pylori  protects itself from the acidic environment of the stomach by residing in the mucous layer of the stomach and also by producing the enzyme urease that breaks down urea into ammonium salts, which serve as a buffer against gastric acidity. H. pylori  is highly motile due to the function of its flagella, which enable the organism to move within the mucous layer of the stomach.


H. pylori  is found in individuals in most areas of the world, but its prevalence is linked to specific geographic region, age, ethnicity and socioeconomic status. Studies frequently suggest that transmission of H. pylori  occurs via fecal-oral and oral-oral routes. In many developing countries, H. pylori  colonization is almost universal by age 20, likely due to population crowding and substandard water sanitation. In the United States, prevalence increases with age.


H. pylori  is found in 90 percent of patients with duodenal ulcers and in 70 to 90 percent of patients with gastric ulcers. H. pylori  infection in fact is the most common cause of non-NSAID-related or non-aspirin-related peptic ulcer disease. Approximately 10 to 20 percent of individuals infected with H. pylori  will eventually develop peptic ulcer disease. Other serious complications of infection include:


  • Atrophic gastritis

  • Gastric adenocarcinoma

  • Gastric lymphoma


Up to 70 percent of individuals infected with H. pylori  experience long periods of presenting very minimal or no symptoms. Prompt detection of  H. pylori  and appropriate intervention and eradication is necessary to minimize the potentially serious complications of infection.


Ulcer disease usually presents symptoms, including: 


  • Gnawing or burning epigastric pain

  • Nausea

  • Vomiting

  • Weight loss

  • Bloating

  • Belching

  • Heartburn

H. pylori  can be transmitted among individuals, and the bacteria may be present in:

  • Saliva

  • Dental plaque

  • Feces 

  • Contaminated food or water 


The bacteria enters the body through the mouth.

Good hygiene is an important way to prevent the spread of H. pylori.  Recommendations to reduce the spread of the bacteria include:

  • Washing hands with soap and water, especially after using the bathroom and before eating

  • Cleaning and cooking foods thoroughly before consuming

  • Only drinking clean, safe water

The diagnosis of H. pylori  infection is important for proper treatment and eradication. Diagnostic tests for H. pylori  can be classified into two categories: invasive tests that require gastric mucosa samples, and noninvasive tests that do not require mucosa samples. Mucosal samples are usually obtained from endoscopic biopsy. Tests that do not require a mucosal biopsy include: 

  • Serologic tests

  • Antigen tests utilizing fecal samples

  • Urea breath tests


Treatment for H. pylori  includes administration of appropriate antibiotics to fight the infection, as well as other medications to heal the stomach lining and reduce pain. Follow-up after four weeks of treatment is recommended to ensure the efficacy of the antibiotic treatment.