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Digestive Disorders > Upper Abdomen

Helicobacter pylori –symptoms, cause and treatment

Dr. med. André Sommer

Dr. med. André Sommer

Helicobacter pylori (H. pylori) is a bacterium that colonizes the human gastrointestinal tract. It is held responsible for the development of many diseases, such as chronic gastritis. It is believed that around 50 percent of the world's population is infected with Helicobacter pylori. Information on what characterizes this bacterium, how it causes various diseases and how to treat an infection with Helicobacter pylori can be found in the following article.

What is Helicobacter pylori?

Helicobacter pylori is a bacterium. Unlike most other bacteria, it has learned how to survive in the human stomach’s acidic environment. It can colonize the mucous membrane (mucosa) in the stomach and cause diseases there via various mechanisms. Approximately half of the world's population carries Helicobacter pylori in their gastrointestinal tract. In Germany and other industrialized countries, however, this number decreases from year to year. Helicobacter pylori is transferred directly from human to human, for example via the saliva. Robin Warren and Barry Marshall received the Nobel Prize for physiology in 2005 for the discovery of Helicobacter pylori and its role in the development of chronic gastritis.

How does Helicobacter pylori survive the acidic environment in the stomach?

Gastric acid has a pH between 1 and 1.5 and is therefore a very strong acid. For example, acetic acid only has a pH of 2. This acidic environment is fatal to most bacteria (bactericidal). H. pylori, however, produces an enzyme that can neutralize acid. It adheres to the stomach wall and creates an acid-free area in its environment where it can survive protected. The immune system reacts to the colonization of the stomach with Helicobacter pylori, but it cannot effectively** fight the bacteria**. It is this permanent activity of the immune system that is responsible for the development of the diseases caused by Helicobacter pylori.

What diseases are caused by Helicobacter pylori infection?

Due to the constant immune response in the stomach, diseases occur such as

  • Chronic gastritis
  • Stomach and duodenal ulcers (Ulcus ventriculi, Ulcus duodeni) and even
  • Tumors in the gastrointestinal area (Gastric carcinomas and so-called MALT lymphomas develop).

Did you know that ... an inflammation of the stomach caused by H. pylori can be effectively alleviated by changing the diet. Every stomach tolerates different foods. As part of professional nutritional therapy, you can learn which foods are particularly good for you. Our therapy is reimbursed by statutory health insurance companies. Click here for more information.

Chronic gastritis from H. pylori

Inflammation of the stomach caused by Helicobacter pylori is known as Type B gastritis (B for bacterial). It is acute after being infected with Helicobacter pylori and can then become a chronic inflammation.

Gastric and duodenal ulcers caused by H. pylori

For a long time stress and psychological stress were regarded as the main cause of stomach ulcers. The discovery of Helicobacter pylori led to a rethinking among medical professionals, because people are now aware that many such ulcers are caused by an infection with the bacteria. Colonization of the gastric mucosa with Helicobacter pylori can lead to areas of the mucous membrane losing their natural protective barrier. You are then attacked by your own stomach acid and ulcers can form. Duodenal ulcers often appear in the part of the duodenum that directly joins the stomach when the bacteria come from the stomach.

Gastrointestinal tumors caused by H. pylori

An infection with H. plyori can lead to the development of so-called MALT lymphomas. These are tumors that arise in the area of gastrointestinal immune system. MALT is the abbreviation for “mucosa associated lymphoid tissue ”, i.e. the immune tissue that surrounds the stomach and intestines. H. pylori infection is also a risk factor for the development of gastric carcinoma.

How is Helicobacter pylori infection diagnosed?

There are several ways to diagnose an infection with the H. pylori bacterium. They are divided into “invasive” and “non-invasive” procedures.

Invasive diagnostic procedures for H. pylori infections Non-invasive diagnostic procedures for H. pylori infections
Gastroscopy (gastroscopy) Blood tests
Tissue examination (biopsy) Saliva, urine and stool tests
Bacterial cultures Breath test

Tab.1: Different methods of diagnosing H. pylori infection

Invasive diagnostic procedures for H. pylori infections

  • Gastroscopy: The doctor recognize inflammatory reactions that happen in the stomach via gastroscopy. In addition, the presence of gastric ulcers may indicate a Helicobacter pylori infection
  • Tissue examination (Biopsy): As part of gastroscopy, the doctor will take tissue samples from inflamed areas of the gastric mucosa. These tissue samples can then be examined under the microscope for the presence of Helicobacter pylori.
  • Bacterial cultures: The bacteria can be grown from the tissue samples obtained during gastroscopy and thus proven.

Non-invasive diagnostic procedures for H. pylori infections

  • Blood tests: A patient's blood can be examined for a specific antibody, which the immune system has formed against parts of the bacterium. Such an examination gives an indication of the extent of the Helicobacter pylori infection
  • Saliva, urine and stool tests: An antibody against parts of Helicobacter pylori can also be found in saliva, urine and stool samples
  • Breath test: With the so-called 13C-urea breath test (C13 breath test) the metabolism of the bacterium is used to detect Helicobacter pylori in the stomach. The patient takes makred urea (13C-urea) with 200 ml of fruit juice. If the patient has Helicobacter pylori in their stomach, the bacterium will convert the urea into carbon dioxide (CO2) which is exhaled. Since the CO2 is then also marked and can be measured, it is possible to draw a conclusion about the presence of the bacteria in the stomach
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How is H. pylori infection treated?

Infection with the H. pylori bacterium is treated with a combination of different drugs. Depending on the combination of medications, the therapy is referred to as “Italian triple therapy”, “French triple therapy” or “Quadruple therapy”.

Therapy regimen Medications
Italian triple therapy Proton pump inhibitor (PPI), clarithromycin, metronidazole
French triple therapy Proton pump inhibitor (PPI), clarithromycin, amoxicillin
Quadruple therapy Proton pump inhibitor (PPI), bismuth salt, tetracycline, metronidazole

Tab.2: Different treatment options for an infection with Helicobacter pylori

How does the therapy work?

All therapies follow a common scheme: They consist of a combination of antibioticsthat kill bacteria, and a gastric protective drug. To protect the stomach, so-called proton pump inhibitors (PPI) are used. This group of drugs includes, for example, pantoprazole and omeprazole. They inhibit the acid production of the stomach and thus protect the stomach acid from attacking your own mucous membrane.

Helicobacter pylori therapy is often also called eradication therapy and lasts about seven days. After this time, the presence of Helicobacter pylori in the gastrointestinal tract is tested again, for example using the 13C-breath tests.

What we eat has a big impact on our digestive health and quality of life. Our certified nutritionists specialize in irritable stomach and H. pylori infections and help you to achieve your personal health goals with tailored nutritional therapy. Learn more about therapy here and arrange a free initial consultation.

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Conclusion: An infection with Helicobacter pylori can go unnoticed for a long time, as the consequences often only become noticeable after some time. Especially in patients who often suffer from gastrointestinal complaints, it is advisable to test for the presence of the bacteria. Eradication therapy can eliminate the symptoms of the infection and effectively prevent subsequent effects.

Kusters, J. G., van Vliet, A. H., & Kuipers, E. J. (2006). Pathogenesis of Helicobacter pylori infection. Clinical microbiology reviews, 19(3), 449-490. Link:, downloaded on 23.07.16
Ricci, C., Holton, J., & Vaira, D. (2007). Diagnosis of Helicobacter pylori: invasive and non-invasive tests. Best Practice & Research Clinical Gastroenterology, 21(2), 299-313.
Link: (Abstract, full text only downloadable with special access, downloaded on 23.07.16
Ruehe, B. (2005). Basics Gastroenterologie. Elsevier, Urban&FischerVerlag.
Malfertheiner, P., Megraud, F., O'Morain, C. A., Atherton, J., Axon, A. T., Bazzoli, F., ... & El-Omar, E. M. (2012). Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut, 61(5), 646-664. Link:, downloaded on 23.07.16
Groß, U. (2013). Kurzlehrbuch Medizinische Mikrobiologie und Infektiologie. Georg Thieme Verlag.
Malaty, H. M. (2007). Epidemiology of Helicobacter pylori infection. Best Practice & Research Clinical Gastroenterology, 21(2), 205-214. Link: (Abstract, full text only downloadable with special access, downloaded on 23.07.16

Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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