Can Helicobacter pylori (H. pylori) infection clear on its own without treatment?

H. pylori Does Not Clear Spontaneously and Requires Treatment

H. pylori infection persists for life if untreated and does not spontaneously resolve. 1, 2 This chronic infection, typically acquired in childhood, remains present for years to decades before diagnosis and will not clear without antimicrobial therapy. 1

Natural History of Untreated H. pylori

• H. pylori establishes lifelong chronic infection that persists indefinitely without eradication therapy. 2
• The infection is typically transmitted in childhood and continues throughout the patient's lifetime if left untreated. 2, 3
• Approximately 50% of the world's population harbors H. pylori infection, making it the most common infectious disease worldwide. 4, 3
• The bacterium has unique properties that allow it to colonize gastric epithelium in the highly acidic stomach environment, where it resides protected from natural clearance mechanisms. 2

Why Spontaneous Clearance Does Not Occur

• H. pylori exists in a location physically outside the body (the gastric lumen), making it poorly accessible to blood-borne antibiotics and the immune system. 1
• The organisms are typically present in vast numbers, creating an inoculum effect that prevents natural clearance. 1
• A proportion of H. pylori attach to gastric cell surfaces creating biofilm, and some exist intracellularly, further protecting them from immune clearance. 1
• H. pylori can become dormant (persister effect), allowing survival even under hostile conditions. 1

Clinical Implications

• Treatment is mandatory because the infection will not resolve on its own and carries significant long-term risks. 1, 2
• Untreated H. pylori causes chronic gastritis that can progress to peptic ulcer disease, gastric cancer, and gastric MALT lymphoma. 1, 2
• The infection is a preventable cause of gastric cancer, one of the most common fatal malignancies worldwide. 1
• There are no indications requiring emergency treatment initiation, as the infection has typically been present for years or decades, allowing time to identify optimal therapy. 1

Treatment Necessity

• Bismuth quadruple therapy for 14 days is the preferred first-line treatment in areas with high clarithromycin resistance. 5, 6
• All patients require test-of-cure at least 4 weeks after completing treatment to confirm eradication. 5, 6
• Without treatment, the chronic infection continues to cause progressive gastric mucosal damage and increases cancer risk over time. 2