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

Symptoms of Helicobacter pylori Infection

H. pylori infection commonly presents with dyspeptic symptoms including epigastric pain, fullness, bloating, and early satiety, with epigastric pain often being the most bothersome and typically acid-related symptom. 1

Common Symptoms

• Epigastric pain or burning (ulcer-like dyspepsia) - often the most prominent symptom
• Fullness, bloating, or satiety (dysmotility-like dyspepsia)
• Early satiation (feeling full after eating small amounts)
• Nausea or vomiting (in some cases)
• Heartburn (may become apparent as the predominant symptom after H. pylori eradication)

Alarm Symptoms Requiring Immediate Attention

H. pylori infection may present with or develop alarm symptoms that require urgent medical evaluation:

• Weight loss
• Progressive dysphagia (difficulty swallowing)
• Recurrent vomiting
• Evidence of gastrointestinal bleeding
• Anemia
• Palpable abdominal mass
• Malabsorption 1

Symptom Patterns

H. pylori infection can manifest in different symptom patterns:

1. Ulcer-like dyspepsia: Characterized by epigastric pain that may be relieved by food or antacids
2. Dysmotility-like dyspepsia: Characterized by early satiety, fullness, bloating
3. Non-specific dyspepsia: Mixed symptoms without a clear pattern

Associated Conditions and Complications

H. pylori infection is associated with several conditions that may present with their own symptom profiles:

• Peptic ulcer disease: Sharp, burning epigastric pain that may worsen with fasting and improve with food
• Gastritis: Gnawing or burning epigastric discomfort, nausea
• Gastric cancer: Progressive weight loss, early satiety, persistent pain
• MALT lymphoma: Often asymptomatic until advanced
• Iron-deficiency anemia: Fatigue, weakness, pale skin
• Vitamin B12 deficiency: Fatigue, weakness, neurological symptoms 1

Important Clinical Considerations

• Many H. pylori infections are asymptomatic, especially in children and young adults
• Symptoms may persist in some patients even after successful eradication of H. pylori
• Symptoms alone cannot reliably distinguish between H. pylori-associated dyspepsia and functional dyspepsia
• Patients over 45 years with dyspeptic symptoms should be referred for endoscopy due to increased risk of gastric cancer 2, 1
• Patients under 45 years without alarm symptoms can be tested and treated for H. pylori without endoscopy 2, 1

Risk Factors for Severe Disease

• Age over 45 years
• Family history of gastric cancer
• Previous gastric neoplasia
• Atrophic gastritis or intestinal metaplasia
• High-risk ethnic backgrounds 1

H. pylori infection affects approximately 50% of the world's population, with higher prevalence in developing countries 3. Understanding the symptom profile is essential for appropriate diagnosis and management, as early detection and eradication can prevent serious complications including gastric cancer.