Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Reflux or indigestion?
- Acid reflux (GERD): burning behind the breastbone (heartburn) or sour fluid coming up into the throat, often worse after meals, lying down or bending
- Dyspepsia (indigestion or gastritis): pain, burning or fullness in the upper stomach, early fullness after small meals, nausea or bloating
- Both can happen together. Heavy, spicy or late meals, tea and coffee on an empty stomach, smoking, extra weight and painkillers such as ibuprofen, diclofenac or aspirin can make symptoms worse
- Chest pain with breathlessness, sweating or pain spreading to the arm or jaw may be the heart, not acidity. Seek urgent care
What is H. pylori?
Helicobacter pylori is a bacterium that can live in the stomach lining for many years. It is very common in Pakistan and many people carry it without any symptoms. In some people it causes gastritis and stomach or duodenal ulcers, and over many years it increases the risk of stomach cancer. Treating it when found lowers these risks.
When should you be tested?
Testing is usually advised if you have:
- Ongoing indigestion or upper stomach pain (dyspepsia)
- A current or past stomach or duodenal ulcer
- Long-term use of aspirin or painkillers planned, especially with a past ulcer
- Unexplained iron deficiency anaemia, or certain blood conditions such as low platelets (ITP)
- A close family member with stomach cancer
- Heartburn alone, without indigestion, is not usually a reason to test for H. pylori
Which tests are reliable?
The recommended tests for active infection are the urea breath test and the stool antigen test. Biopsies taken during an endoscopy can also be tested. A blood antibody test is not reliable for showing current infection or cure, because it can stay positive after the germ has gone.
To avoid false negative results, acid-reducing tablets such as omeprazole or esomeprazole are usually stopped 2 weeks before a breath or stool test, and antibiotics and bismuth 4 weeks before. Ask your doctor before stopping any medicine.
Treatment and confirming cure
Treatment is a combination of an acid-reducing medicine with two or more antibiotics, often with bismuth, usually for 14 days. Antibiotic resistance is common in Pakistan, so the choice of regimen matters and taking every dose matters even more.
Because treatment does not always work first time, a breath or stool test is advised at least 4 weeks after finishing treatment to confirm the infection has gone. If it has not, a different regimen is used. Repeating the same antibiotics, or taking left-over courses, is best avoided.
Simple steps that help acidity
- Eat smaller meals and leave 2 to 3 hours between dinner and lying down
- Raise the head end of the bed if night-time heartburn is a problem
- Cut down on smoking, very oily or spicy food, fizzy drinks and late-night tea if they trigger symptoms
- Avoid regular painkillers like ibuprofen or diclofenac without medical advice
- Do not take acid tablets for months without review. Long-term use should be decided with a doctor
When to seek medical help urgently
- Vomiting blood or material like coffee grounds
- Black, tarry stools
- Difficulty or pain when swallowing, or food sticking
- Unintended weight loss or loss of appetite
- Repeated vomiting
- Anaemia or new symptoms at an older age, especially over about 60
- Chest pain with breathlessness, sweating or spreading to the arm or jaw
In an emergency go to the nearest emergency department or call Rescue 1122. Do not wait for a WhatsApp reply.
Common questions
Does everyone with acidity have H. pylori?
No. Many people with acidity do not have H. pylori, and many people with H. pylori have no symptoms. Testing is useful when there is ongoing indigestion or an ulcer.
Why should I stop my acid tablet before the test?
Acid-reducing tablets can suppress the germ and give a falsely negative breath or stool test. They are usually stopped 2 weeks before. Your doctor can suggest something for symptoms in the meantime.
Can H. pylori come back after treatment?
Reinfection is possible but uncommon in adults. More often, the first treatment did not fully clear it. That is why a test of cure after at least 4 weeks is recommended.
Do I need an endoscopy for acidity?
Most people do not. An endoscopy is advised if there are warning signs, if symptoms continue despite treatment, or depending on age and other risk factors.
Would you like Dr Usman Naeem to look at your case?
Consultations are available in clinic in Lahore or online. Message on WhatsApp 0332-0420421 or 0334-0421313, or call or SMS 0311-4444600. The clinic will confirm a day and time.
Ask about an online consultation on WhatsAppBook an AppointmentRelated videos by Dr Usman Naeem
From Dr Usman Naeem’s own YouTube channel (mostly Urdu). They load only when you press play.
H. Pylori Treatment Failing? Discover the Real Reasons Why H. Pylori Infection Keeps Coming Back
Watch on YouTubeIs Your Stomach In Danger? 5 Important Questions You Should Ask About Your Stomach Health
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- Cirrhosis Diet: What to Eat and What to Avoid
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Sources and further reading
- Chey WD et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2024;119:1730–1753. Link
- Malfertheiner P et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut 2022;71:1724–1762. Link
- Moayyedi PM et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol 2017;112:988–1013. Link
- Katz PO et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022;117:27–56. Link
General information only, not personal medical advice. Do not start or stop medicines because of this article. See the medical disclaimer.