How is H. pylori diagnosed?

With a urea breath test, a stool antigen test, or biopsies taken during upper endoscopy. Blood antibody tests are not recommended because they stay positive after the infection is gone.

How is H. pylori treated?

With a combination of antibiotics and an acid-reducing medicine for 14 days. Common regimens include bismuth quadruple therapy, rifabutin triple therapy (Talicia), and vonoprazan-based therapy (Voquezna).

Do I need to be retested after treatment?

Yes. Everyone treated for H. pylori should have a breath or stool test at least 4 weeks after finishing antibiotics, and after stopping acid-reducing medicines for 2 weeks, to make sure the infection is gone.

Does H. pylori cause stomach cancer?

H. pylori is the strongest known risk factor for stomach cancer. Treating it lowers that risk, which matters especially for Chinese, Korean, Vietnamese, and other Asian Americans, who have higher rates of stomach cancer.

Should my family be tested?

H. pylori often spreads within families. Your doctor may suggest testing family members who live with you, especially if anyone has a history of stomach cancer.

H. Pylori Infection: Symptoms, Testing, and Treatment

Helicobacter pylori (H. pylori) is a bacterium that infects the lining of the stomach. It is usually picked up in childhood and can stay for life unless treated. It is a leading cause of stomach ulcers and the strongest known risk factor for stomach cancer.

Symptoms

Most people with H. pylori have no symptoms. When symptoms occur, they may include:

Burning or gnawing pain in the upper belly, often worse on an empty stomach
Nausea, bloating, and frequent burping
Loss of appetite or unintended weight loss

Get care right away for black, tarry stools, vomiting blood, or severe belly pain, which can signal a bleeding ulcer.

How it spreads

H. pylori spreads from person to person through saliva, vomit, or stool, often within families, and through contaminated food or water. It is more common in people who grew up in Asia, Latin America, Eastern Europe, and other areas where the infection is widespread, and in crowded living conditions.

Complications

Gastritis (inflammation of the stomach lining)
Peptic ulcers of the stomach or duodenum, which can bleed
Iron-deficiency anemia
Stomach cancer and a rare stomach lymphoma (MALT lymphoma)

Who should be tested

People with a current or past peptic ulcer
People with ongoing indigestion (dyspepsia)
People with a family history of stomach cancer, or who come from regions with high rates of stomach cancer
Long-term aspirin or NSAID users at risk for ulcers
People with unexplained iron-deficiency anemia or low platelets (ITP)
Family members living with someone who has H. pylori

Testing

Urea breath test: you drink a solution and breathe into a bag.
Stool antigen test: a small stool sample.
Biopsy during upper endoscopy, which can also check for ulcers and early cancer.

For accurate results, stop proton pump inhibitors (PPIs) for 2 weeks and avoid antibiotics and bismuth (Pepto-Bismol) for 4 weeks before a breath or stool test, if it is safe to do so. Blood antibody tests are not recommended because they cannot tell a past infection from a current one.

Treatment options

Treatment combines two or three antibiotics with an acid-reducing medicine, taken for 14 days. Because H. pylori has become resistant to clarithromycin in many areas, current guidelines favor these regimens:

Bismuth quadruple therapy: a PPI, bismuth, tetracycline, and metronidazole. Often the first choice.
Rifabutin triple therapy (Talicia): omeprazole, amoxicillin, and rifabutin.
Vonoprazan-based therapy (Voquezna Dual or Triple Pak): vonoprazan, a strong acid blocker, with amoxicillin (with or without clarithromycin).

Your doctor chooses a regimen based on your allergies (especially penicillin), past antibiotic use, and earlier treatments. Take every dose for the full 14 days, even if you feel better. Side effects can include a metallic taste, nausea, and loose stools; avoid alcohol while taking metronidazole. If the first treatment does not work, a different regimen, sometimes guided by antibiotic resistance testing, usually does.

Confirming the cure

Everyone treated should be retested with a breath or stool test at least 4 weeks after finishing treatment (and 2 weeks off PPIs). This step is important because treatment does not always work the first time.

H. pylori and stomach cancer in Asian Americans

Chinese, Korean, Vietnamese, Japanese, and other Asian Americans have higher rates of stomach cancer. Finding and treating H. pylori lowers that risk. If you have a family history of stomach cancer, talk with us about testing and whether an upper endoscopy is right for you. Read more in stomach cancer risk and screening in Asian Americans (also in 中文 and Tiếng Việt).

Make an appointment

Our gastroenterologists in Temple City care for patients from Arcadia, San Gabriel, Pasadena, Monrovia, Monterey Park, and across the San Gabriel Valley. We accept most PPO plans (see accepted insurances), and our doctors speak English, Vietnamese, and Mandarin. Schedule an appointment or call 626-898-4560.

This article is for general education and is not a substitute for medical advice. Talk with your doctor about your own health.