H. pylori infects two-thirds of the world's population, but often goes underdiagnosed or misdiagnosed. If left untreated, H. pylori can cause ongoing GI discomfort, peptic ulcers, and gastric cancer.
As healthcare providers, we must ensure prompt testing and treatment for H. pylori. Too often, we treat only the symptoms of H. pylori, rather than the root cause.
H. pylori causes vague symptoms that overlap with many gastrointestinal conditions, or may have no symptoms. Patients are often unable to find accurate information about what may be causing their abdominal discomfort, or they may have been misdiagnosed, potentially several times over. If your patient reports persistent gastrointestinal upset, ruling out H. pylori infection is a straightforward and practical first step in identifying the underlying cause. H. pylori is a leading cause of gastric cancer; early identification and treatment of this common infection are crucial.
Symptoms are often nonspecific and may present similarly to a wide array of common gastrointestinal concerns, such as GERD, irritable bowel disease, celiac disease, anxiety, or lactose intolerance. Proton pump inhibitors may mask symptoms. When patients present with these symptoms, consider performing prompt H. pylori testing before prescribing PPIs.
Patients at highest risk include:
H. pylori bacteria (green) binding to a piece of pre-cancerous gastric tissue (blue). The researchers found that during chronic infection, H. pylori genetically adapts to the pre-cancerous stomach environment, and these genetic changes increase adherence to stomach tissue.
Image provided by Dr. Valerie O'Brien, Purdue University
Because H. pylori symptoms can be vague or overlap with other GI conditions, it's important to know what to look for. Review the list of common and alarm symptoms to better identify at-risk patients.
Testing options include blood serology, urea breath test, stool antigen, or polymerase chain reaction (PCR) tests. Some test options do not differentiate between past and current infection, and are therefore less useful in determining a treatment plan. Endoscopy may be indicated for patients with more severe symptoms (see symptoms page).
Antibiotics may be used to treat H. pylori, and PPIs can be prescribed for symptom management.
Patients should be retested after the first round of treatment to ensure thorough eradication of the infection.
Access the latest guidelines from the American Gastroenterology Association (AGA) and the American College of Gastroenterology (ACG).