H. Pylori: Patient Education Guide
What is H. Pylori?
H. pylori is a common bacterial infection in your stomach that affects up to 50% of people worldwide and causes inflammation (gastritis) that can lead to ulcers and, rarely, stomach cancer. 1, 2 The good news is that this infection can be cured with antibiotics and acid-reducing medications. 1
Why Should You Get Tested?
You should be tested for H. pylori if you have: 1, 3
- Stomach pain or indigestion (dyspepsia) that won't go away
- Current or past stomach or duodenal ulcers
- Family history of stomach cancer or ulcers
- Long-term use of aspirin or anti-inflammatory medications (NSAIDs) like ibuprofen
- Unexplained anemia (low iron or vitamin B12)
- Family members living with you who have H. pylori
If you're under 45-50 years old without warning signs (no weight loss, bleeding, difficulty swallowing, or anemia), you can be tested without needing an endoscopy first. 1 If you're over 50 or have any of these warning symptoms, you'll need an endoscopy (camera test) to look directly at your stomach. 1, 4
How is H. Pylori Diagnosed?
The two best non-invasive tests are the urea breath test and stool antigen test, both with accuracy rates above 93%. 4 These tests detect active infection without requiring an endoscopy. 1, 4
Important Testing Rules:
- Stop proton pump inhibitors (PPIs like omeprazole, esomeprazole) for at least 2 weeks before testing to avoid false-negative results 4
- Stop antibiotics for at least 4 weeks before testing 4
- Never use blood antibody tests to confirm cure – they stay positive even after successful treatment 4
How is H. Pylori Treated?
The most effective first-line treatment is bismuth quadruple therapy for 14 days, which cures over 90% of infections. 1, 5 This includes:
- Bismuth (like Pepto-Bismol)
- Two antibiotics (typically metronidazole and tetracycline)
- A proton pump inhibitor (PPI) taken 30 minutes before meals 1
Alternative First-Line Options:
If bismuth therapy isn't available, your doctor may prescribe: 1, 5
- Rifabutin triple therapy for 14 days: Rifabutin + amoxicillin + high-dose PPI
- Concomitant therapy for 14 days: PPI + amoxicillin + clarithromycin + metronidazole (only in areas with low clarithromycin resistance) 3
Important Treatment Details:
- Take medications with meals to minimize stomach upset 6
- Complete the full 14-day course even if you feel better 1
- Use high-dose PPIs – at least 40 mg omeprazole (or 20 mg esomeprazole/rabeprazole) twice daily 1
- Avoid pantoprazole as it's less effective than other PPIs 1
What If the First Treatment Doesn't Work?
If treatment fails, you'll need a different antibiotic combination for 14 days. 5 Options include:
- Bismuth quadruple therapy (if not used initially) 5
- Levofloxacin triple therapy: Levofloxacin + amoxicillin + PPI (only if susceptibility confirmed) 1, 5
- Rifabutin triple therapy (if not used initially) 5
After two failed treatments, your doctor should perform an endoscopy with bacterial culture to test which antibiotics will work. 7, 5
Confirming Cure
You must be retested at least 4 weeks after finishing treatment to confirm the infection is gone. 4 Use either:
Never use blood antibody tests for confirmation – they cannot distinguish between active and past infection. 4
Why Treatment Matters
Curing H. pylori prevents ulcers from coming back in over 90% of cases and reduces your risk of stomach cancer. 1 If you take NSAIDs regularly, eradicating H. pylori cuts your ulcer risk in half. 8
Common Side Effects and Tips
Treatment side effects may include: 1
- Nausea or upset stomach
- Diarrhea
- Metallic taste
- Dark stools (from bismuth – this is normal)
To reduce side effects: 3
- Take all medications with food
- Consider taking probiotics during treatment
- Stay well-hydrated
- Report severe diarrhea, rash, or allergic reactions to your doctor immediately