Helicobacter pylori explained

What is Helicobacter pylori?

Helicobacter pylori (H. Pylori for short) is a bacterium, a kind of germ, which lives in the sticky mucus that lines the stomach. About 40% of people in the UK have H. pylori in their stomach so it is very common. In nearly nine out of 10 people who have H. pylori, it does not cause any problems.

How do people get it and can they pass it on?

People who do have H. pylori almost always catch it in childhood, probably from other children or family members. Once someone picks up H. pylori, it stays in the stomach throughout life unless it is treated with particular antibiotics. H. pylori is actually becoming less common and nowadays it is unusual for children to catch it, even if someone else in the family has it. People living in the UK today who have H. pylori are unlikely to pass it on and do not need to take any special measures to avoid giving it to others.

What problems can H. pylori cause?

About 15% of people with H. pylori infection get ulcers either in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer). Although ulcers tend to cause indigestion, occasionally they become much more serious as they can bleed or even burst (perforate) which happens if the ulcer burrows deep enough actually to make a hole. People with ulcers should therefore be treated with the aim of getting rid of H. pylori.

Bad indigestion is common and there are many other reasons why people get this symptom other than having ulcers. Because there are millions of people who have both H. pylori and indigestion, it can be tempting to draw the conclusion that one leads to the other. This is simply not the case in the vast majority of people.

Does H. pylori cause cancer?

It is true to say that H. pylori is associated with a very slightly increased risk of stomach cancer. However, treating H. pylori simply to reduce this risk is not generally advised for three reasons. Firstly, the risk of any of us getting stomach cancer is small. Secondly, no-one knows whether treating H. pylori once you are an adult will actually reduce the risk of developing stomach cancer at all. Thirdly, although treatment is usually very
straightforward, a course of antibiotics does carry a small risk of a bad reaction and indeed the problems that the treatment may cause can outweigh any possible benefit.

Might H. pylori even be good for us?

Some experts think that H. pylori, like other bacteria living in our gut, may be good for us. However, no-one has yet found a definite advantage from having it although a number of theories have been put forward.
 

Does treating H. pylori make you better?

If you have an ulcer

Before we knew about H. pylori, ulcers did heal up with acid-reducing drugs only to come back when the treatment was stopped. Treating H. pylori not only helps ulcers to heal but, more importantly, it greatly reduces the risk of the ulcer coming back in the future. Although H. pylori is the cause of most ulcers, there are some which are caused by aspirin and similar drugs used to treat joint and muscle problems. Nevertheless, all doctors are agreed that patients with H. pylori should have treatment for the infection if they have, or ever have had, an ulcer.

If you don’t have an ulcer

Less than one person in 10 with the combination of indigestion and H. pylori infection, but who don’t have an ulcer, will feel better as a result of treatment. Many doctors consider the disadvantages of taking a course of antibiotics are just not worth the small chance of the treatment helping. It is fair to say that there are doctors who would recommend treating H. pylori even without an ulcer being present. They do this in the hope of making a small number of such people feel better.

If you have indigestion but neither you nor your doctor know if you have an ulcer

Until recently most people with bad indigestion often had an endoscopy to see whether or not an ulcer was present. Nowadays, people with indigestion who also have worrying symptoms such as weight loss, persistent vomiting or trouble in swallowing still need to have an endoscopy. But, otherwise, most patients are treated without the need to have that examination. Instead, many doctors test their patients with indigestion to see if they have H. pylori and, if the test is positive, they treat the infection. However, without an endoscopy, the doctor just cannot know whether or not an ulcer is present. If the patient has actually had an ulcer, we know that treating H. pylori is likely to prove successful. In other cases where H. pylori has not caused an ulcer, there may very well be no improvement.

 H. pylori - greatly magnified