Medically reviewed by Dr Usman Naeem, 24 Oct 2026.
Key points
- H. pylori is very common, particularly in South Asia, and is usually acquired in childhood.
- It is diagnosed by a breath test, a stool antigen test or biopsies at endoscopy. Acid-lowering medicines and recent antibiotics can cause a false negative result.
- Treatment is usually a combination of antibiotics and an acid-lowering medicine for about 14 days, selected with local resistance in mind. Taking every dose matters.
- Treatment does not always work first time, so a repeat test at least 4 weeks after finishing antibiotics confirms that it has gone.
Overview
H. pylori infects the lining of the stomach and causes ongoing inflammation (gastritis). In some people it leads to a peptic ulcer in the stomach or duodenum. Over decades it increases the risk of stomach cancer and a rare lymphoma, which is why treatment is advised when it is found, especially with ulcers or a family history of stomach cancer.
Antibiotic resistance, particularly to clarithromycin and metronidazole, is a problem in many regions, so older, shorter “triple therapy” regimens fail more often. Current guidelines favour regimens such as bismuth-based quadruple therapy for 14 days where resistance is likely, but the right choice depends on your history, allergies and local patterns. Your doctor will choose it.
Causes and risk factors
- Infection, probably through close contact and contaminated food or water, often in childhood
- Crowded living conditions and poor sanitation increase the chance of infection
- Regular use of anti-inflammatory painkillers (ibuprofen, diclofenac, aspirin) is a separate cause of ulcers and also raises the risk when combined with H. pylori
Symptoms
- Upper abdominal pain or burning, sometimes related to meals
- Nausea, bloating, early fullness, belching
- Many people have no symptoms
When to seek urgent medical care
- Vomiting blood, black stools, or sudden severe abdominal pain (a bleeding or perforated ulcer is an emergency)
- Weight loss, persistent vomiting, difficulty swallowing, or anaemia
In an emergency go to the nearest emergency department or call Rescue 1122.
How it is assessed
- Urea breath test or stool antigen test: reliable and non-invasive. Stop PPIs for 2 weeks and antibiotics for 4 weeks before testing, but only if your doctor says it is safe
- Upper endoscopy with biopsies when there are alarm features or ulcers are suspected
- Blood antibody tests are not useful to check if the infection has cleared
Treatment
Treatment
- A combination of antibiotics and an acid-lowering medicine, usually for 14 days. The exact combination depends on your allergy history and previous antibiotic use
- Take every dose. Side effects such as metallic taste, loose stools or nausea are common; ask before stopping any tablet
- Repeat testing at least 4 weeks after the end of antibiotics (and 2 weeks off PPIs if advised) to confirm it has cleared. If it has not, a different combination is used
- Do not take leftover antibiotics or start courses on your own: incomplete treatment fuels resistance
What you can do
- Avoid anti-inflammatory painkillers unless your doctor advises them
- Avoid smoking and heavy alcohol, which slow ulcer healing
- Wash hands and use clean drinking water and properly cooked food
- Ask your doctor whether family members with symptoms should be tested
Common questions
Why does H. pylori keep coming back?
Most “recurrence” in the first year is actually the infection never fully clearing, usually because antibiotics were resistant, doses were missed or the wrong test timing hid it. Reinfection after real clearance is less common. A repeat test after treatment shows which it is.
Do I need treatment if I have no symptoms?
Treatment is generally advised when H. pylori is found, because it can cause ulcers and raises the long-term risk of stomach cancer. Your doctor will advise you.
Can probiotics replace antibiotics?
No. Some probiotics may reduce side effects in some people, but they do not clear H. pylori on their own.
اردو خلاصہ
ایچ پائلوری معدے میں رہنے والا ایک جرثومہ ہے جو معدے کی سوزش اور السر کا سبب بن سکتا ہے۔ اس کا پتا سانس کے ٹیسٹ، پاخانے کے ٹیسٹ یا اینڈوسکوپی کی بایوپسی سے چلتا ہے۔
علاج میں عموماً کئی اینٹی بائیوٹکس اور تیزابیت کم کرنے والی دوا تقریباً 14 دن شامل ہوتی ہے۔ پورا کورس مکمل کریں، خود سے دوا شروع یا بند نہ کریں، اور علاج کے کم از کم 4 ہفتے بعد دوبارہ ٹیسٹ کروائیں تاکہ معلوم ہو کہ جرثومہ ختم ہوا یا نہیں۔
Videos on this topic
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H. Pylori Treatment Failing? Discover the Real Reasons Why H. Pylori Infection Keeps Coming Back
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This page gives general information prepared for Dr Usman Naeem and is not personal medical advice. See the medical disclaimer.