Symptoms of H. Pylori Infection
Most people infected with H. pylori remain asymptomatic, but when symptoms occur, they present as dyspeptic symptoms including epigastric pain or burning, early satiation, postprandial fullness, nausea, and bloating. 1
Common Symptomatic Presentations
When H. pylori infection causes symptoms, patients typically experience:
- Dyspeptic symptoms are the most common presentation, manifesting as upper abdominal discomfort or epigastric pain 1
- Epigastric pain or burning that may be persistent or intermittent 2
- Early satiation and postprandial fullness (feeling full quickly during or after meals) 2
- Nausea and bloating as associated symptoms 1
The key clinical point is that H. pylori infection always causes chronic gastritis at the microscopic level, but this inflammation is often clinically silent—up to 50% of the world's population carries H. pylori yet most never develop complications 3, 4.
Alarm Symptoms Requiring Urgent Evaluation
Certain symptoms indicate potentially serious complications and mandate immediate specialist referral with endoscopy, regardless of age:
- Anemia (suggesting chronic blood loss) 2, 1
- Unintentional weight loss 2, 1
- Dysphagia (difficulty swallowing) 2, 1
- Palpable abdominal mass 2, 1
- Evidence of gastrointestinal bleeding (hematemesis or melena) 2
- Persistent vomiting 2
These alarm features are critical because H. pylori infection can progress to serious complications including peptic ulcer disease, gastric cancer, and gastric MALT lymphoma 5, 6.
Age-Related Symptom Significance
The same dyspeptic symptoms carry different clinical implications based on patient age:
- Patients under 45 years without alarm symptoms can be managed with non-invasive H. pylori testing in primary care 2, 1
- Patients 45-55 years or older with new-onset dyspepsia require endoscopy due to increased gastric cancer risk, even without alarm symptoms 2
- The age cutoff may be lower in regions with higher gastric cancer incidence 2
Important Clinical Caveats
Many infected patients remain completely asymptomatic—H. pylori can persist for life without causing noticeable symptoms, yet still increase long-term risks of peptic ulcer and gastric malignancy 4, 6. This is why the "test and treat" strategy is recommended even in minimally symptomatic young patients with dyspepsia lasting more than 4 weeks 2.
Additionally, symptoms may not reliably predict the presence or severity of underlying pathology—patients with significant gastric inflammation or even early ulcer disease may have minimal symptoms, while others with functional dyspepsia may have severe symptoms without serious pathology 2, 7.