Ulcers and Helicobacter Pylori (H. Pylori) Overview

It is estimated that 25 million Americans – nearly 1 in 10 – will develop ulcers in her or his lifetime.

Today, approximately 20% of Americans under 40, and half of those over 60, are infected with the Helicobacter Pylori (H. Pylori) bacteria, and the link between the bacteria and ulcers has been clearly established.

Destroying the Long-held Medical Myth on the Cause of Ulcers

The bacteria H. pylori was first discovered in 1875 by German scientists. However, it was not until the 1980s when the medical world began to realize that the ‘spicy food and stress causes ulcers’ theory was incorrect.

The H. pylori bacteria was further studied by Robin Warren and Barry Marshall, Australian pathologists. For their H. pylori research, they won the 2005 Nobel Prize in Physiology or Medicine after disproving the long-held misconception. 

As part of the experiments, Marshall ingested a dish of H. pylori and developed gastritis. They confirmed that there was H. pylori in his stomach lining, which they cured with bismuth salts and metronidazole, an antibiotic.

Up until then, only antacids were used to ineffectively treat ulcers because of the incorrect ‘spicy food and stress causes ulcers’ theory. 

Based on their research, in 1994 the National Institutes of Health USA (NIH) stated that H. pylori caused the majority of recurrent gastric ulcers and recommended that antibiotics should be used for ulcer treatment regimens starting. 

H. Pylori Infection Signs, Symptoms, and Conditions

Most people infected with H. pylori experience no or very mild symptoms. However, if people with an H. pylori-related illness may experience the following:

  • Aching or burning pain in the abdomen
  • Appetite changes with weight loss
  • Bloating
  • Bloody or black tarry stools
  • Bloody vomit or vomit that looks like coffee grounds
  • Frequent belching
  • Nausea
  • Vomiting

Depending on the disorder caused by H. pylori, the signs and symptoms may vary in length and severity.

It is not known why some people are more likely to develop stomach ulcers than others. However, there are several theories regarding the cause.

One theory suggests that genetic factors play a role in susceptibility to H. pylori infection. Another theory suggests that the relative degree of harm caused by different strains of H. pylori bacteria may be responsible for the development of ulcers.

Disorders related to H. pylori include:

  • Gastric mucosa-associated lymphoid tissue (MALT) – the development of a cancerous tumor from white blood cells in the stomach lining
  • Gastritis – an inflamed stomach lining
  • Non-ulcer dyspepsia stomach discomfort or pain not caused by an ulcer or other condition associated with pain
  • Stomach or duodenal ulcers (also known as peptic ulcers) – these are open sores in the stomach lining or beginning of the small intestine 
  • Stomach cancer – when abnormal stomach cells divide uncontrollably

Once H. pylori has taken up residence in the stomach, it will be a constant presence in the host’s intestines. Over time, an H. pylori infestation can lead to:

  • Chronic inflammation
  • Damage to the stomach lining
  • Jeopardize vital acid-producing stomach glands
  • Risk for developing more serious diseases such as stomach cancer

That’s why it’s crucial to seek treatment if you have H. pylori.

Ulcer Symptoms

The most common ulcer symptom is abdominal discomfort, which is a dull, gnaw­ing ache that comes on and off for several days or weeks. It usually occurs two or three hours after eating, or at night when you’re sleeping.

The pain associated with an ulcer can be relieved by taking antacids. However, the underlying H. pylon infection needs to be treated so that the ulcer heals.

Like an H. pylori infection, peptic ulcer symptoms include bloating, burping, poor appetite, nausea, weight loss, and vomiting.

If any of these symptoms below appear, it is important to notify your doctor:

  • Sharp, sudden, severe, and persistent stomach pain
  • Difficulty swallowing
  • A full or bloated sensation after a small meal
  • Bloody or black granules in stool
  • Bloody vomit or vomit that looks like coffee grounds

What Causes Ulcers?

An H. pylori bacterial infection is one of the most common causes along with long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen sodium.

Some types of cancerous tumors in the stomach or pancreas may cause ulcers.

Causes of H. Pylori Infection

It is not known exactly how H. pylori is contracted, but it is generally believed that it can be transmitted orally through ingesting fecal matter contaminated food or water. Make sure any water you drink is clean water. 

Some researchers believe that close person-to-person contact, such as exposure to vomit, is another way this type of bacteria can be passed along.

Some evidence also suggests that H. pylori, a contagious bacterium, can be transmitted through mouth-to-mouth contact.

Diagnosing an H. Pylori-related Ulcer

When an ulcer has been diagnosed, doctors test patients for H. pylori in order to determine the appropriate course of treatment. A gastric ulcer caused by H. pylori is treated different than one caused by an NSAIDs.

Blood, breath, stools, and tissue tests are often used to diagnose H. pylori infection.

A blood test will reveal whether the person has ever been infected with H. pylori bacteria. If so, antibodies against H pylori will be present in their blood.

Breath tests can detect H. pylori with high accuracy by allowing the release of a tagged, radioactive carbon when the patient drinks an urea solution. The urea is broken down by H. pylori, releasing the carbon which gets carried to the lungs and exhaled. Breath tests are also useful for confirming the absence of H. pylori after treatment. However, PPI medications can interfere with these tests.

Stool sample tests detect H. pylori-associated antigens in feces to diagnose H. pylori infection.

Tissue tests use biopsied cells taken from the stomach lining to detect the presence of specific enzymes made by H. pylori. They’re used to identifying the actual bacteria under the microscope, or to grow H. pylori from a tissue sample

Treating H. Pylori and Related Ulcers

Since the groundbreaking work by Nobel Prize winning scientists, ulcer patients who have been diagnosed with H pylori infection are usually treated for one to two weeks using a combination antibiotic and PPI drugs which suppress stomach acid.

The antibiotics will kill the H pylori bacteria in infected people. Drugs that suppress stomach acid are used to reduce the release of hydrochloric acid into the digestive tract.

The goal of this treatment is to kill the H. pylori bacteria while letting the ulcers heal. A two-week course of antibiotics normally has a 70-90 percent efficacy rate for reducing ulcers, killing H pylori bacteria and preventing recurrence.

Pharmaceutical Drug Treatments for H. pylori-related Ulcers

Treating peptic ulcers can be done with this triple therapy of pharmaceutical drugs.

  • Antibiotics: amoxicillin, clarithromycin, metronidazole, tetracycline/doxycycline, levofloxacin, nitazoxanide, rifabutin
  • Proton pump inhibitors (PPIs): esomeprazole, lansoprazole, omeprazole, pantoprozole, and rabeprazole
  • Stomach-lining protector: bismuth subsalicylate (i.e. Pepto-Bismol)

Pharmaceutical drug therapy have proven to be extremely successful at treating H. pylori infections, there there are downsides, including side effects like nausea, GI upset, diarrhea, headaches and dizziness.

Many people have turned to alternative and complementary treatments after experiencing the side effects of these drugs.

Alternative or Complementary Treatments for H. Pylori-related Ulcers

The triple therapy described here is difficult for some people because it requires taking up to twenty-four pills a day and may cause unpleasant side effects.

Probiotic supplements may be useful for patients who have antibiotic-resistant bacteria in their guts. The benefits of probiotics include effectiveness in reducing symptoms associated with H. pylori-induced gastritis.

Sulforaphane is an anti-microbial and anti-cancer compound found in cruciferous vegetables such as collard greens, broccoli, kale, cabbage, cauliflower, and Brussel sprouts. Sulforaphane is one of the active ingredients found in broccoli sprouts. Studies show that consuming broccoli sprouts may inhibit the growth of H. pylori in some patients.

Prevent H. Pylori

Preventing H. pylori infection is the same as protecting yourself from a variety of infections:

  • Wash your hands thoroughly with warm, soapy wash water after eating and/ or using the toilet.
  • Don’t share glasses or utensils; H. pylori bacteria is believed to be transmitted by saliva.
  • Avoid drinking or eating anything that has been contaminated by flood water or sewage.

H. Pylori Therapies

Stomach ulcers are usually caused by an infection called H. pylori. It’s one of the most common bacteria all over the world; causing stomach lining inflammation, and may be associated with stomach cancer.

While multiple-drug strategy therapies are effective, they can be complicated and related to numerous unpleasant side effects and difficulty with compliance due to the number and frequency of pills.

Treatment is important as this can help reduce the risk of recurrent ulcers, GI bleeding, and even stomach cancer.

Written and Medically Reviewed By

  • Julie Guider, M.D.

    Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.