Helicobacter pylori Infection
A common stomach bacterium — often silent, but a major cause of ulcers and certain stomach cancers. Cured with a 14-day course of antibiotics.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
H. pylori is a spiral-shaped bacterium that lives in the lining of the stomach. It is one of the most successful human pathogens — more than half the world's population has it. Many people never know they're infected, but in some it causes inflammation (gastritis), ulcers, and rarely stomach cancer or lymphoma.
How common is it?
Saudi Arabia has high prevalence — around 50–60% of adults are infected, with rates higher in older generations and lower in younger ones due to improved sanitation. Often acquired in childhood from family members.
Why does it happen?
Spread person-to-person through saliva, stool-contaminated water or food, or shared utensils. Living in crowded conditions or with infected family members is the main risk factor.
Symptoms
- No symptoms in most people
- Burning stomach pain, especially when hungry or at night
- Bloating, feeling full quickly
- Nausea, sometimes vomiting
- Loss of appetite or weight loss
Red flags — seek urgent medical care
Vomiting blood or coffee-ground material
Bleeding ulcer — emergency department.
Black, tarry stools
Upper GI bleeding — emergency.
Sudden severe stomach pain
Possible perforated ulcer — go to ED immediately.
Persistent vomiting, especially with weight loss
Could be gastric outlet obstruction or malignancy.
How is it diagnosed?
Urea breath test — accurate, non-invasive; you swallow urea and breathe into a tube. Best for diagnosis and to confirm cure.
Stool antigen test — also non-invasive, accurate.
Endoscopy with biopsy — gold standard if symptoms suggest ulcer. Allows direct testing of stomach tissue.
Blood antibody test — only shows past exposure; not useful for current infection or to confirm cure.
Stop PPIs for 2 weeks before breath or stool tests for accuracy.
Outlook — what to expect
First-line treatment cures around 80–90% of patients in Saudi Arabia. Resistance is rising — second-line and third-line regimens are highly effective for treatment failures. Once eradicated, reinfection is rare in adults.
Treatment
Habits & Lifestyle
Habits do not cure H. pylori but reduce ongoing irritation while you take treatment.
- Stop NSAIDs (ibuprofen, diclofenac) and aspirin if possible.
- Stop smoking — reduces eradication success.
- Avoid alcohol during treatment, especially with metronidazole.
- Eat regular small meals.
Diet
No specific diet cures H. pylori, but some foods help symptoms.
- Probiotics (yogurt, kefir, supplements) may improve eradication and reduce side effects of antibiotics.
- Limit very spicy or fatty food during treatment.
- Cranberry juice may help in addition to (not instead of) standard treatment.
Medications
First-line treatment in Saudi Arabia is bismuth quadruple therapy (PPI + bismuth + tetracycline + metronidazole) for 14 days due to high clarithromycin resistance. Take EVERY dose — incomplete treatment causes resistance.
- Bismuth quadruple therapy: PPI twice daily + bismuth + tetracycline + metronidazole, all for 14 days.
- Concomitant therapy: PPI + amoxicillin + clarithromycin + metronidazole — alternative first-line.
- Confirm cure with urea breath test or stool antigen 4 weeks AFTER finishing antibiotics (and 2 weeks off PPI).
- Side effects of treatment: nausea, metallic taste, dark stools (from bismuth — harmless), diarrhea.
Procedures & Surgery
No procedures treat H. pylori — but endoscopy is needed in some scenarios.
- Endoscopy if alarm symptoms or age >50.
- Surveillance endoscopy if H. pylori has caused atrophic gastritis or intestinal metaplasia.
In the Saudi context
All H. pylori medications are widely available in Saudi pharmacies and covered by all major insurance plans. The MOH offers free testing and treatment in primary care for high-risk patients.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Should everyone in my family be tested?
- Why do I need a 14-day course instead of shorter?
- When should I retest to confirm cure?
- What if my treatment doesn't work the first time?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026