What Are the First Symptoms of H. pylori?

H. pylori is a common species of stomach bacteria, part of the “normal flora” in billions of people globally. This bacteria in some people, however, can grow out of control, causing GERD, ulcers, and rarely, stomach cancer.

Helicobacter pylori (H. pylori) is a bacterium commonly found in the stomachs of about one-half of the world's population. For most people, H. pylori infection does not cause any problems or symptoms, but in some people, H. pylori infection can cause digestive problems, including ulcers and, much less commonly, stomach cancer.

What Are Symptoms of H. pylori?

Most people with H. pylori infection have no symptoms. In people who have ulcers due to H. pylori, the first symptoms of ulcers include: 

• Pain or discomfort in the upper abdomen
• Feeling full after eating a small amount of food
• Bloating
• Gas
• Loss of appetite
• Nausea 
• Vomiting
• Belching (burping)

Later symptoms of a stomach ulcer include:

• Dark or black-colored stools
• Unusual weight loss
• Ulcers that bleed can cause a low blood count (anemia)
• Fatigue
• Shortness of breath
• Severe abdominal pain

H. pylori infection is diagnosed with a patient history and physical examination, and tests that may include:

• Blood tests
• Breath tests (urea breath tests)
• Stool tests
• Biopsy of tissue from the lining of the stomach
• Endoscopy

Treatment for H. pylori infection usually involves taking several medications for 14 days.

• Proton pump inhibitors (PPIs) to decrease the stomach acid production 
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Pantoprazole (Protonix)
  • Rabeprazole (aciphex)
  • Dexlansoprazole (Dexilant)
  • Esomeprazole (Nexium)
• Two antibiotics are usually recommended along with a PPI to reduce the risk of treatment failure and antibiotic resistance
  • Bismuth quadruple therapy: bismuth subsalicylate, metronidazole, tetracycline, and a PPI given for 14 days 
  • Clarithromycin triple therapy: clarithromycin, amoxicillin, and a PPI, all given twice daily for 14 days
  • Concomitant therapy: a clarithromycin, amoxicillin, a nitroimidazole (tinidazole or metronidazole), and a PPI administered together for 10 to 14 days
  • Hybrid therapy: amoxicillin and a PPI for seven days followed by amoxicillin, clarithromycin, a nitroimidazole, and a PPI for seven days 
  • Levofloxacin triple therapy: levofloxacin, amoxicillin, and a PPI for 10 to 14 days
  • Levofloxacin quadruple therapy: levofloxacin, omeprazole, nitazoxanide, and doxycycline (LOAD) for 7 or 10 days (additional studies are needed to confirm the efficacy of this regimen and its cost-effectiveness)
  • Levofloxacin sequential therapy: amoxicillin and a PPI for five to seven days followed by levofloxacin, amoxicillin, a nitroimidazole and a PPI for five to seven days

Many patients with H. pylori have an infection that is resistant to antibiotics, so it is important to take the entire course of all medications prescribed and to get a blood or stool test to confirm the infection has been cleared.

Complications of H. pylori infection include: 

• Need for repeat treatment
  • As many as 20% of patients are not cured after the first course of treatment
• Chronic gastritis
• Can lead to some forms of cancer (uncommon)
  • Gastric adenocarcinoma 
  • Gastric MALToma 
  • Squamous cell esophageal cancer
• Idiopathic thrombocytopenic purpura
• Peptic esophagitis