How to treat Helicobacter pylori positivity?

Written by Wang Jing Bin
Gastroenterology
Updated on December 19, 2024
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A positive test for Helicobacter pylori requires distinguishing the specific method used for detection. If it is a positive result from a Helicobacter pylori antibody test, a breath test, including both the Carbon-14 and Carbon-13 breath tests, should be conducted. If the breath test comes back positive, further examinations are necessary, including gastroscopy and analysis of Helicobacter pylori virulence factors. The analysis of virulence factors can help determine if the Helicobacter pylori infection is highly toxic. If positive, it may indicate a potential for severe gastric diseases and necessitate treatment. For individuals with a positive Helicobacter pylori breath test, a gastroscopy is also recommended, as it is the only way to precisely determine the type of gastric disease present, such as ulcers or gastritis. Depending on the gastroscopy results, some individuals may need eradication treatment for Helicobacter pylori, especially those with a history of gastric ulcers, a family history of gastric cancer, gastric polyps, erosive gastritis, or gastric mucosa-associated lymphoid tissue lymphoma. Others, if the virulence factor analysis is negative, might not require immediate treatment for Helicobacter pylori. However, if a patient insists on treatment for Helicobacter pylori, it can be considered, but it must be clear that there are risks involved and that the treatment should be conducted properly. Finally, treatment for Helicobacter pylori is not recommended for minors, i.e., individuals under 18 years of age.

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Written by Peng Miao Yun
Internal Medicine
1min 5sec home-news-image

What should I do if I have a Helicobacter pylori infection?

Helicobacter pylori is closely related to the occurrence of chronic gastritis, gastric ulcers, and gastric cancer, but not everyone infected with Helicobacter pylori will develop chronic gastritis or gastric ulcers. Infections can be diagnosed with a breath test, where values more than twice the normal level, accompanied by symptoms of gastritis, gastric ulcers, stomach distension, stomach pain, and acid reflux, should be considered for antibacterial and stomach-protective treatment. Generally, with standard treatment, 90% of Helicobacter pylori can be eradicated within one to two weeks. However, reinfection is common as it can be found in food and utensils and transmitted through saliva. It is generally advised that children under 14 and individuals with low levels of Helicobacter pylori without obvious stomach inflammation symptoms do not require immediate treatment.

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Written by Wu Hai Wu
Gastroenterology
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What should I do if Helicobacter pylori infection is not cured after two treatments?

If Helicobacter pylori infection has not been cured after two treatments, it is necessary to consider the possibility of bacterial resistance or that the treatment was not standardized. It is advisable to visit the gastroenterology department of a hospital. Based on the doctor's experience, it may be necessary to adjust the medication plan. The choice of specific medications and their dosage should be determined according to the doctor's prescription. During the treatment period, one should eat easily digestible food and avoid spicy and irritating foods, as well as avoid drinking alcohol, strong tea, coffee, etc. It is also important to eat slowly and avoid overeating or drinking excessively.

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Written by Jiang Guo Ming
Gastroenterology
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Helicobacter pylori symptoms

Helicobacter pylori itself is just a bacterium, often parasitizing the stomach or oral cavity of the human body. It cannot be said that Helicobacter pylori has symptoms, but rather that symptoms may occur after being infected by Helicobacter pylori. Many normal people infected with Helicobacter pylori may not exhibit any discomfort. However, if Helicobacter pylori causes gastritis or peptic ulcers, etc., related symptoms may appear. For instance, abdominal pain, bloating, belching, acid reflux, and so on; in cases of peptic ulcers, corresponding symptoms, such as periodic, recurrent episodes of upper abdominal pain associated with eating and so forth, may also occur and will need to be determined based on the specific situation.

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Written by Wang Hui Jie
Gastroenterology
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Can a gastroscopy detect Helicobacter pylori?

Since Helicobacter pylori is a type of bacterium, it cannot be seen with the naked eye. However, current research indicates that Helicobacter pylori is strongly associated with certain mucosal appearances under endoscopy. Therefore, endoscopists can infer the presence of an infection based on certain mucosal appearances observed during the procedure. However, if the only purpose is to test for Helicobacter pylori infection without needing a gastroscopy, then we can opt for non-invasive methods such as the carbon-13 urea breath test, carbon-14 urea breath test, stool antigen test, and serological antibody tests, which are commonly used methods of testing. Moreover, after treatment for Helicobacter pylori, it is recommended to use either the carbon-13 or carbon-14 urea breath test for examination.

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Written by Huang Ya Juan
Gastroenterology
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How to eradicate Helicobacter pylori

The spontaneous clearance rate of Helicobacter pylori infection is extremely low, meaning that it is almost impossible to cure itself. If not treated medically, it may lead to a lifelong infection. Currently, the consensus both domestically and internationally on handling Helicobacter pylori is that eradication requires combination therapy with multiple drugs, categorized into triple therapy and quadruple therapy, with a treatment duration of 2 weeks. Triple therapy consists of a proton pump inhibitor (PPI) plus two antibiotics. We currently use quadruple therapy, which includes two antibiotics, a gastric mucosal protectant, and a proton pump inhibitor. The choice of these drugs is complex. Common anti-inflammatory drugs include amoxicillin, clarithromycin, metronidazole, and levofloxacin; in cases of bacterial resistance, we recommend using furazolidone or tetracycline. Specific medications should be consulted in detail with a doctor. After the treatment course, we need to assess whether the eradication was successful, with a re-examination one month after stopping the drugs. After the eradication of Helicobacter pylori, the rate of reinfection in adults is very low, but the reinfection rate in children is somewhat higher than in adults. Not everyone infected with Helicobacter pylori needs eradication; it is necessary only for those with ulcers, erosion, atrophy, or related symptoms.