What Is Helicobacter Pylori and How to Test for It?

Helicobacter pylori is a bacterium that can survive in the stomach and cause inflammation (gastritis). It causes a gnawing upper abdominal pain that is often described as indigestion. It used to be thought that bacteria could not survive in the stomach because of the highly acidic environment (the pH in the stomach is around 2.0). Helicobacter is able to not only survive but it can multiply and cause an infection, an inflammation of the stomach. Helicobacter attach to the lining of the stomach hiding in the mucus secreted by stomach cells. Not surprisingly, people who do not produce much stomach acid (a condition called achlorhydria) are more susceptible to Helicobacter infection.

What are the symptoms?

Gnawing upper abdominal pain or discomfort that tends not to go away but is fairly constant is the most common symptom. Sometimes a bloating feeling is noticed and yet some people have no symptoms at all.

How is Helicobacter spread?

It is difficult to be certain but it appears likely that Helicobacter is not generally spread from person to person. The reason we can be fairly certain of this is that when a person is found to be infected there is a very low risk of their partner or other family members becoming infected. If Helicobacter was easily spread from person to person this would not be the case.

It is much more likely that spread of Helicobacter occurs after contamination of surfaces that we touch. For example, if a person with Helicobacter uses a public toilet and does not wash their hands properly if tiny pieces of faeces are present on their fingers it can be transferred to taps, door handles etc. In the stool there will be very many Helicobacter that have been washed out of the stomach with food and drink. The next person to use the tap or door handle can pick up the bacteria and when they eat they may transfer the bacteria to their mouth. Another person has become infected. This commonly happens abroad in less developed countries where standards of hygiene may be quite poor. We have found people returning from foreign holidays having contracted this disease.

If an infected person is careful about their hygiene it unlikely they will pass the infection on.

What are the risks?

Helicobacter causes inflammation and that can lead to an ulcer forming. Ulcers can bleed if they erode into blood vessels. Bleeding can cause anaemia, fatigue and fainting. Longstanding inflammation of the stomach is a risk factor for the development of stomach cancer.

What tests are available?

Helicobacter Stool test - recommended

A very convenient test and accurate also, the Helicobacter stool test identifies the bacteria directly by an immunological reaction. This means that the test is specific for Helicobacter, that is to say that the test will only be positive when Helicobacter is present and other bacteria will not make this test positive. Helicobacter bacteria pass into the stool from the stomach as they are washed from the stomach with food and drink.

This test comes highly recommended yet it is not widely used in hospitals or General Practice. The accuracy of the test can be adversely affected if antibiotics or proton pump inhibitors such as Omeprazole, have been taken within 2-4 weeks of the test.

Helicobacter Blood test - not recommended

This test is no longer recommended because it tests for the antibodies the body's immune system makes when Helicobacter is present. This test does not detect the bacteria itself. Antibodies to Helicobacter can remain in the blood long after the infection has gone and antibodies may not be present in the blood in the early phase of the infection. This test should be avoided.

Helicobacter Breath test - recommended

A widely used and highly effective test equivalent in accuracy to the stool test, this test is suitable for people who prefer not to handle their stool. The test detects 'urease-producing bacteria.' Helicobacter bacteria produce the enzyme urease. The infected person takes a tablet containing urea labelled with C13 or C14. If urease (Helicobacter) is present the urea is split into ammonia and carbon dioxide that then carries the C13 or C14 label. The carbon dioxide is absorbed into the blood and is then breathed out. A sample of breath is collected and tested for C13 or C14. This test is said to be appropriate even during the prescribing of Omeprazole and related drugs.

Gastroscopy - biopsy and CLO test - only if recommended by your doctor

Gastroscopy is commonly carried out for people with symptoms of a stomach problem to see if there is an ulcer or a tumour in the stomach. At the time of the endoscopy a tissue sample (biopsy) can be taken and tested for Helicobacter using the CLO test or it can be examined under the microscope to visualise the bacteria directly. These tests are very accurate but require endoscopy and sedation so it is an expensive and time-consuming procedure.

Who should be tested?

Anyone with the primary symptom of upper abdominal gnawing pain should be tested. Anyone concerned about the risk of stomach cancer with or without symptoms and anyone who has finished a course of treatment for a Helicobacter infection more than one month ago should be tested.

What is the treatment?

Bacterial infections are usually treated with antibiotics and Helicobacter infection is no exception. A combination of antibiotics is prescribed along with some medication to help the symptoms.

Are there alternative treatments?

Many alternative treatments have been discovered but few have been shown to actively kill Helicobacter. Some alternative treatments probably work by suppressing Helicobacter rather than killing it. Treatments that I have come across include manuka honey, matula tea and herbal treatments.

How effective is treatment?

About 90% of infections are successfully treated with one course of antibiotics (triple therapy). The 10% of patients who suffer a relapse can be treated with a second course of different antibiotics. It is best to have a Helicobacter test one month after treatment to check if eradication of the bacteria has been successful.