Helicobacter pylori (H. pylori) is a common stomach infection. Many people carry it without symptoms, but in others it causes burning, indigestion, nausea, ulcers or iron deficiency. Treating it properly and confirming cure are crucial.
I have simplified the key points in the video below, and this page provides a helpful overview of the latest tests and treatments. However, each patient’s needs are unique. Treatment should always be guided by a qualified gastroenterologist. This page is for general educational purposes only.
What is an H. pylori infection?
Helicobacter pylori is a spiral-shaped bacterium living in the stomach lining. Globally, up to 70–90% of infected individuals have no symptoms, but in others H. pylori contributes to:
- Burning upper abdominal discomfort
- Bloating and early fullness
- Indigestion / dyspepsia
- Nausea or loss of appetite
- Peptic ulcers and bleeding
- Iron deficiency anaemia
- Increased long-term stomach cancer risk
How do we test for H. pylori?
The aim is to confirm active infection, not past exposure. The most accurate tests are:
- Urea breath test (accuracy ~95%)
- Stool antigen test (accuracy ~90–95%)
- Gastroscopy with biopsies when clinically indicated
Older blood antibody tests are no longer recommended because they remain positive even after the infection has gone.
Modern first-line H. pylori treatment – updated guidelines
For many years, standard triple therapy was widely used. Due to rising antibiotic resistance, it is no longer the preferred first-line option.
New international guidelines recommend:
14-day bismuth-based quadruple therapy (BQT)
- Proton pump inhibitor (PPI)
- Bismuth
- Tetracycline
- Metronidazole
Newer options – vonoprazan and rescue therapy
Vonoprazan is a newer potassium-competitive acid blocker (P-CAB) that provides stronger, more stable acid suppression. Clinical trials show higher eradication rates than older regimens.
- Used for difficult-to-treat or previously failed cases
- Useful when strong acid suppression is required
- A tailored approach is essential
If treatment has already failed
- Review the previous treatment course
- Evaluate compliance and timing
- Consider alternative treatment regimens
- Assess for other causes such as reflux, functional dyspepsia or SIBO
When is endoscopy recommended?
- Age >40–45 with new symptoms
- Alarm symptoms (weight loss, vomiting, anaemia, bleeding)
- Persistent symptoms despite treatment
- Strong family history of stomach cancer
Retesting after treatment
- Test-of-cure at least 4 weeks after completing antibiotics
- Stop PPIs for ~2 weeks before the test to avoid false negatives
If you wish to discuss this further or would like to make an appointment, please use the booking form on this page. A member of our team will contact you within 12 business hours.
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