What are the symptoms of Helicobacter pylori (H. pylori) infection?

From the Guidelines

Helicobacter pylori infection often causes no symptoms, but when symptoms do occur, they typically include burning or gnawing abdominal pain, nausea, bloating, frequent burping, and unintentional weight loss. Some people may experience loss of appetite, vomiting, or dark stools. H. pylori can cause chronic gastritis (stomach inflammation) and is strongly associated with peptic ulcers and an increased risk of stomach cancer. The bacteria damages the protective mucous coating of the stomach and duodenum, allowing stomach acid to irritate the sensitive lining beneath. Symptoms may worsen after eating spicy foods, acidic foods, or alcohol. If you suspect H. pylori infection, diagnostic tests include breath tests, blood tests, stool tests, or endoscopy with biopsy. Treatment typically involves "triple therapy" - a combination of two antibiotics (such as amoxicillin and clarithromycin) plus a proton pump inhibitor (like omeprazole) taken for 10-14 days, as recommended by the most recent guidelines 1. This regimen has a success rate of 70-90% for eradicating the infection. After treatment, follow-up testing is recommended to confirm the bacteria has been eliminated.

Key points to consider:

• H. pylori infection is a common cause of peptic ulcer disease and gastric cancer 1
• The infection can be diagnosed using non-invasive tests such as breath tests, blood tests, and stool tests 1
• Treatment should be tailored to the individual patient, taking into account factors such as antibiotic resistance and patient preferences 1
• Follow-up testing is essential to confirm eradication of the infection and prevent recurrence 1

In terms of management, the American Gastroenterological Association recommends that patients with dyspepsia be evaluated for H. pylori infection and treated if positive 1. The Maastricht consensus report also recommends a "test and treat" approach for patients with dyspepsia, using non-invasive tests to diagnose H. pylori infection and treating those who are positive 1. Overall, the goal of treatment is to eradicate the infection, reduce symptoms, and prevent complications such as peptic ulcers and gastric cancer. The most effective treatment regimen is a combination of two antibiotics and a proton pump inhibitor, taken for 10-14 days, as recommended by the most recent guidelines 1.

From the Research

H pylori Symptoms and Diagnostic Methods

• The symptoms of H pylori infection can be diagnosed using various methods, including invasive techniques such as endoscopy and biopsy, as well as non-invasive techniques like serology, urea breath test, and stool antigen test 2, 3, 4, 5, 6.
• Non-invasive tests can be categorized into 'active tests' that detect active infection, such as the urea breath test and stool antigen test, and 'passive tests' that are markers of exposure to H pylori but do not indicate if active infection is ongoing, such as serology 4, 5.
• The choice of diagnostic method depends on factors like patient age, presenting symptoms, medication use, test reliability, availability, and cost 3, 4, 5.

Diagnostic Accuracy of Non-Invasive Tests

• A systematic review of 101 studies found that the diagnostic accuracy of non-invasive tests for H pylori infection varied, with urea breath test-13C having the highest diagnostic odds ratio, followed by urea breath test-14C, serology, and stool antigen test 6.
• The sensitivity and specificity of these tests also varied, with urea breath test-13C having the highest sensitivity and specificity, followed by urea breath test-14C, serology, and stool antigen test 6.
• The review highlighted the need for further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests 6.

Limitations and Future Directions

• The diagnostic accuracy of non-invasive tests for H pylori infection can be affected by various factors, including the threshold used to define test positivity, the staining techniques used for histopathological examination, and the presence of antibiotics or proton pump inhibitors 6.
• Further studies are needed to identify the best thresholds for each test and to compare the diagnostic accuracy of different tests in a representative spectrum of participants 6.