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H Pylori & Stomach Ulcers

One of the things that makes me especially unhappy is when doctors send patients home telling them that H pylori is harmless and that everyone has it. This does happen, and I have the emails saved in my folders to prove it.

Of all the symptoms or ‘diseases’ in which Helicobacter pylori infection plays a role, ulcers are probably the best known. If you’ve had an ulcer, you’ll know that it can be a pretty unpleasant experience.

In fact, H pylori gained notoriety almost purely from the fact that it is the single most important contributing factor in the development of stomach (or peptic) ulcer disease.

In 2005, Drs. Barry Marshall and Robin Warren were awarded the Nobel Prize in physiology and medicine for proving to the medical establishment (after 20 years of trying) that H pylori infection causes ulcers.

In medicine, the damage caused to the stomach lining by H pylori is classified into two distinct groups:


Malignancy pertains to cancer. In the case of H pylori, MALT lymphoma and adenocarcinoma are malignant diseases that can be caused by the infection. Both of these conditions are forms of cancer.


Non-malignant diseases are those that do not cause cancer. Examples include gastritis, dyspepsia, GERD and ulcers. The majority of H pylori infections lead to non-malignant conditions rather than malignant ones.

Ulcers themselves can be prefixed by ‘stomach’, ‘peptic’ or duodenal. Stomach/peptic ulcers occur in the stomach, whereas duodenal ulcers develop in the small intestine.

It is believed that the non-malignant disease can eventually become malignant over a period of time if H pylori bacteria are not eradicated.

Peptic Ulcer Disease (PUD)

Ulcers are well known complications of H pylori infection. The mechanisms by which H pylori causes the ulcers is still debatable and it may be that only certain strains of H pylori bacteria are actually capable of causing ulcers. These strains likely include Cag-A, Bab-A and Vac-A.

The latest literature on H pylori and ulcers – from the medical journal Helicobacter – indicates that infection with the bacteria leads to a 15-20% chance of developing an ulcer.

Considering that around half the world’s population carries H pylori, that’s a lot of ulcers!

Peptic Ulcer Symptoms

Peptic ulcers will tend to cause the following symptoms:

  • Nausea
  • Vomiting
  • Burning sensation in the stomach / chest
  • Heartburn
  • Acid reflux (GERD, dyspepsia)
  • Stomach pain
  • Lump in throat / difficulty swallowing
  • Pain between shoulder blades

Symptoms sometimes worsen at night or when lying down and may be worse around meal times when the stomach is producing more acid.

Ulcer Complications – Bleeding Ulcers

The most common complication in PUD is bleeding. According to authors DeVries & Kuipers, writing in Helicobacter, bleeding ulcers occur in approximately 10-20% of patients who have H pylori-associated PUD.

Bleeding ulcers are a major cause of morbidity and mortality. The term morbidity refers to the fact that something may not cause death, but it really makes you feel crap. Mortality is obviously another word for death.

So we have to take H pylori, the fact that it causes ulcers that, in some people, may bleed, very seriously indeed.

Bleeding Ulcer Management

Bleeding ulcers will tend to cause the same symptoms as those listed above.

However, if bleeding does occur, other signs may be present and it’s very important to look out for these if ulcers are suspected and symptoms are severe:

  • Severe stomach pain
  • Vomiting blood
  • Vomiting that contains coffee-like granules
  • Dark, tarry stools

If these symptoms are present, you must seek medical attention immediately.

A recent international consensus (Annal Intern Med: 2010;152:101-113) strongly recommended to always test patients with peptic ulcer bleeding for H pylori infection and that H pylori-positive patients all need eradication therapy followed by testing to confirm eradication.

The report also indicated that testing ought to be repeated during follow-up to ensure a greater degree of accuracy.

Other Causes of Peptic Ulcers

H pylori infection is not the only cause of PUD. Other causes include:

  • Non-steroidal anti-inflammatory drugs, or NSAIDS (aspirin, ibuprofen, naproxen)
  • Alcohol abuse (alcohol directly damages stomach lining)
  • Eating smoked foods and those loaded with nitrate and nitrites (check food labels, especially meats such as bacon, chorizo, salami, etc).
  • Cigarette smoking
  • Idiopathic (no known cause)

How Does H Pylori Cause Ulcers?

As we know, H pylori infection always causes active gastritis (inflammation of the stomach lining). It is believed that ulcers result from a progression of events due to this inflammation.

The current literature seems to suggest that it’s actually the host (i.e. me or you) and they way we interact with the H pylori bacteria that may determine whether or not ulcers develop.

For example, certain kinds of immune cells and inflammatory mediatory chemicals (interleukins, cytokines, for example) increase and others decrease in people who have ulcers compared to those who don’t.

So is the outcome of having H pylori due to the bacteria, or is it a combination of “them and us”?

We must also remember that there are many, many different strains of H pylori. In my book I cite a study where multiple strains of the bacteria were detected in one person.

This makes the interaction between us as individuals and the different sub-types of H pylori even more complex!

I’m sure research will uncover the answers in years to come but whatever the mechanisms of causation of ulcers (and cancer) are, I simply know this:

“If you have H pylori, get rid of it!”

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