What are the typical symptoms of Helicobacter pylori infection?

Symptoms of Helicobacter pylori Infection

Most people infected with H. pylori remain completely asymptomatic throughout their lives, never developing any symptoms despite harboring chronic gastritis. 1, 2

The Asymptomatic Majority

• Up to 50% of the world's population carries H. pylori, yet the majority never experience any symptoms or complications. 3
• All infected individuals develop chronic gastritis on biopsy, but this inflammation remains clinically silent in most cases. 4, 2
• The infection persists for life if untreated, typically acquired in childhood and maintained asymptomatically into adulthood. 2

When Symptoms Do Occur: Dyspepsia

When H. pylori does cause symptoms, the most common presentation is dyspepsia—recurrent or persistent upper abdominal pain or discomfort. 5

Typical dyspeptic symptoms include:

• Recurrent or persistent upper abdominal pain, particularly epigastric discomfort that may be gnawing or burning in character 5
• Bloating in the upper abdomen 5
• Nausea associated with upper abdominal symptoms 5
• Early satiety or postprandial fullness (though these are less specific) 5

These symptoms are non-specific and cannot reliably distinguish H. pylori infection from other causes of dyspepsia. 5

Alarm Symptoms Indicating Serious Complications

The following symptoms signal potential peptic ulcer disease, bleeding, or gastric malignancy and mandate immediate endoscopic evaluation regardless of age: 6, 5

• Gastrointestinal bleeding (hematemesis, melena, or hematochezia) 6
• Unintentional weight loss 6
• Progressive dysphagia (difficulty swallowing) 6
• Recurrent vomiting 6
• Iron-deficiency anemia or unexplained anemia 6, 5
• Palpable abdominal mass 6

Disease-Specific Presentations

Peptic Ulcer Disease

• H. pylori is present in 66% of duodenal ulcers and 55% of gastric ulcers. 5
• Peptic ulcer symptoms include epigastric pain that may be relieved or worsened by eating, depending on ulcer location. 7, 8
• Duodenal ulcer pain classically occurs 2-3 hours after meals or at night (though this pattern is not universal). 8
• Complications such as bleeding, perforation, or gastric outlet obstruction present with alarm symptoms listed above. 8

Acute H. pylori Infection (Rare Recognition)

• Acute infection causes transient hypochlorhydria and gastrointestinal upset, though this phase is rarely diagnosed clinically because it occurs in childhood and resolves spontaneously. 8

Gastric Cancer and MALT Lymphoma

• These serious complications typically develop silently over decades and present late with alarm symptoms such as weight loss, anemia, or palpable mass. 4, 2
• Gastric MALT lymphoma may present with dyspepsia, but diagnosis requires endoscopy with biopsy. 9

Critical Clinical Context

The absence of symptoms does not exclude H. pylori infection or its associated risks. 2

• Chronic gastritis progresses silently to atrophic gastritis and intestinal metaplasia—premalignant conditions that increase gastric cancer risk exponentially with age. 4
• Screening and treatment in high-risk populations (family history of gastric cancer, immigrants from high-prevalence regions) is recommended even without symptoms. 5

Common Pitfalls

• Do not assume dyspepsia in a patient under 50 without alarm symptoms is benign—test for H. pylori using non-invasive methods (urea breath test or monoclonal stool antigen test). 6, 5
• Do not attribute vague abdominal symptoms to "stress" or "functional dyspepsia" without first excluding H. pylori, especially in patients from high-prevalence populations. 5
• Never ignore alarm symptoms at any age—these mandate immediate endoscopy, not empiric H. pylori testing. 6
• Recognize that patients over 50-55 years with new-onset dyspepsia require endoscopy, not non-invasive testing, due to rising gastric cancer incidence. 6, 5