Patient Handout – Helicobacter pylori

How to treat Helicobacter pylori infection

By Thais Langer, PhD

Helicobacter pylori (H. pylori) are bacteria usually transmitted through contaminated water or food but can also be passed from person to person. H. pylorus is one of the most prevalent chronic bacterial infections in humans, affecting more than half the world´s population.

H. pylori infect the digestive tract, causing chronic gastritis that may develop into peptic ulcer disease (inflammation on the lining of your stomach, small intestine or oesophagus). When not treated, peptic ulcers may develop into gastric cancer.

H. pylori infection most frequently happens during childhood. People can be infected and have no symptoms for several years.

What are the treatment options?

The treatment involves taking a combination of medications for about two weeks and aims to kill the bacteria and reduce acid production (reducing inflammation) simultaneously.

The treatment may feel intense due to the number of pills you take each day. It is very important, however, that you strictly follow your doctor’s guidelines to avoid H. pylori building resistance against the antibiotics used.

The medications include:

  • Antibiotics(to kill the bacteria):  usually two types of antibiotics are combined to prevent bacteria from developing resistance. Your doctor will select the antibiotics based on known H pylori resistance patterns in your region.  It is also important that you inform your doctor regarding previous exposure to specific antibiotics. The antibiotics chosen are among the following: amoxicillin, clarithromycin, metronidazole, tetracycline, or tinidazole.
  • Proton pump inhibitors (PPI) (to stop over-production of acid): there are different options of PPI to use. Your doctor may base her/his decision on availability, the cost-effectiveness of the dose and drug interaction. Usually, a prescription for generic omeprazole or esomeprazole is the most common option. Other choices are: dexlansoprazole, lansoprazole, pantoprazole, or rabeprazole.
  • Histamine blockers (to block histamine receptors and diminish acid production): there are different options of H2 blockers: cimetidine, famotidine, nizatidine, or ranitidine. They may differ in potency and duration of action.

Studies have shown that clarithromycin should be avoided if you had any previous exposure to macrolide antibiotics (erythromycin, clarithromycin, azithromycin, fidaxomicin and telithromycin) or if you live in an area where clarithromycin resistance for H pylori is known to be high. Inform your doctor about macrolide exposure so he/she may select the right combination of antibiotics. 

If you are allergic to penicillin, you should avoid taking amoxicillin. Remember to inform your doctor regarding any allergies so she/he can adjust your treatment accordingly.

Bismuth subsalicylate (commonly used to treat upset stomach, heartburn and diarrhoea) may be recommended additionally for coating the line of the affected area and protect it from the higher amount of acid produced.

If you have a complicated ulcer (an open sore caused by severe inflammation), your doctor may recommend you take PPI to diminish inflammation and reduce the pain first.

If you follow your doctor’s instructions correctly, you won’t need to repeat the treatment.

There are specific guidelines for the treatment of H. pylori infection, according to local antibiotic resistance patterns. These guidelines are set by the American College of Gastroenterology (ACOG), the European Helicobacter Study Group and the Canadian Association of Gastroenterology (CAG).

Are there any possible side effects?

Not everyone experience side effects from H. pylori infection treatment. If side effects occur, they are related to the digestive tract and may include:

  • Abdominal cramps
  • Diarrhoea
  • Metallic taste
  • Nausea or vomiting
  • Headache
  • Skin rash

We are all different and may react differently to each treatment. If you feel any discomfort – even if not listed above – tell your doctor before stopping the treatment.

If you get a headache during the treatment, check with your doctor before taking any painkillers. Headache medications can be sometimes aggressive for the stomach.

What happens after treatment?

One or two weeks after treatment, you may need to repeat breath or stool test to ensure the bacteria is eradicated. Your doctor will advise you on how to proceed after treatment.

Your physician may recommend an endoscopy after treatment in case you:

  • Have close relatives that developed gastric cancer
  • Have been previously treated for severe gastritis or gastric neoplasia (lesion with uncontrolled growth of cells)
  • Have been often exposed to heavy dust, coal, quartz, etc.
  • Had chronic gastritis for more than one year
  • Are a heavy smoker

Where can you get more help?

You can find more help and information regarding H. pylori infection and treatment at the below resources:

If you would like to get more information regarding stomach cancer, check the American Cancer Society website.