What should I do if I have a Helicobacter pylori infection?

Written by Peng Miao Yun
Internal Medicine
Updated on September 29, 2024
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Helicobacter pylori is closely related to the occurrence of chronic gastritis, gastric ulcers, and gastric cancer, but not everyone infected with Helicobacter pylori will develop chronic gastritis or gastric ulcers. Infections can be diagnosed with a breath test, where values more than twice the normal level, accompanied by symptoms of gastritis, gastric ulcers, stomach distension, stomach pain, and acid reflux, should be considered for antibacterial and stomach-protective treatment. Generally, with standard treatment, 90% of Helicobacter pylori can be eradicated within one to two weeks. However, reinfection is common as it can be found in food and utensils and transmitted through saliva. It is generally advised that children under 14 and individuals with low levels of Helicobacter pylori without obvious stomach inflammation symptoms do not require immediate treatment.

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What are the symptoms of Helicobacter pylori infection?

Helicobacter pylori is a pathogen produced in the stomach or oral cavity. It cannot be said that Helicobacter pylori causes any specific symptoms, rather, it is the infection of Helicobacter pylori that leads to a series of diseases presenting symptoms. Some people infected with Helicobacter pylori may not show any symptoms at all. If related diseases occur, such as gastritis or ulcers, symptoms such as acid reflux, heartburn, nausea, and vomiting may appear. Additionally, some patients, like those with refractory iron deficiency anemia or idiopathic thrombocytopenic purpura, may also have conditions associated with Helicobacter pylori infection.

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How to eradicate Helicobacter pylori

The spontaneous clearance rate of Helicobacter pylori infection is extremely low, meaning that it is almost impossible to cure itself. If not treated medically, it may lead to a lifelong infection. Currently, the consensus both domestically and internationally on handling Helicobacter pylori is that eradication requires combination therapy with multiple drugs, categorized into triple therapy and quadruple therapy, with a treatment duration of 2 weeks. Triple therapy consists of a proton pump inhibitor (PPI) plus two antibiotics. We currently use quadruple therapy, which includes two antibiotics, a gastric mucosal protectant, and a proton pump inhibitor. The choice of these drugs is complex. Common anti-inflammatory drugs include amoxicillin, clarithromycin, metronidazole, and levofloxacin; in cases of bacterial resistance, we recommend using furazolidone or tetracycline. Specific medications should be consulted in detail with a doctor. After the treatment course, we need to assess whether the eradication was successful, with a re-examination one month after stopping the drugs. After the eradication of Helicobacter pylori, the rate of reinfection in adults is very low, but the reinfection rate in children is somewhat higher than in adults. Not everyone infected with Helicobacter pylori needs eradication; it is necessary only for those with ulcers, erosion, atrophy, or related symptoms.

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Can a gastroscopy detect Helicobacter pylori?

The examination with a gastroscope mainly focuses on checking for any damage to the mucous membranes of the stomach and esophagus. It can detect gastritis, gastric ulcers, or stomach cancer. For some patients who might have a tendency toward cancerous changes, a pathological examination can be conducted. However, testing for Helicobacter pylori with a gastroscope requires a separate lab test. Therefore, routine gastroscopic examinations generally do not include testing for Helicobacter pylori. If testing for Helicobacter pylori is needed, it is a separate examination item. Nowadays, since undergoing a gastroscopy can be quite uncomfortable and cause symptoms like nausea for some people, testing for Helicobacter pylori is accurately conducted using a breath test.

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How to treat duodenal ulcer with Helicobacter pylori infection?

The treatment of duodenal ulcer accompanied by Helicobacter pylori infection begins primarily with anti-Helicobacter pylori therapy. The regimen includes a proton pump inhibitor, two types of antibiotics, and a bismuth agent, lasting a total of 14 days. In addition, for duodenal ulcers, it is necessary to use acid-suppressing and stomach-protecting medications to promote gastric mobility and protect the gastric mucosa, with the treatment course lasting six weeks. At the same time, it is important to focus on a light and easily digestible diet, avoiding smoking and drinking alcohol, as well as avoiding strong tea, coffee, spicy, irritating, fried, grilled, raw, cold, and sweet foods. It is also crucial to avoid adverse emotional effects such as anxiety, depression, and stress, prevent excessive fatigue or staying up late, and it is advised to moderately increase physical activity.

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How to treat Helicobacter pylori infection

Currently, the infection rate of Helicobacter pylori in our country has exceeded 50%. The carbon-14 breath test can be used to detect the presence of Helicobacter pylori infection. If the infection is positive and is accompanied by some symptoms or diseases of the digestive system, eradication treatment for Helicobacter pylori is required. The treatment regimen consists of a proton pump inhibitor, two antibiotics, and a bismuth agent, lasting for 14 days. After stopping the medication for a month, the carbon-14 breath test is rechecked to confirm whether the Helicobacter pylori has been converted to negative. If the conversion is negative, it indicates that the eradication treatment for Helicobacter pylori was successful. Helicobacter pylori has been confirmed as the main cause of chronic gastritis, peptic ulcer, and gastric cancer, thus if the Helicobacter pylori infection is positive, eradication treatment is necessary.