Helicobacter Pylori: To Treat or Not to Treat?

shutterstock_331545305Helicobacter pylori is a bacteria that only exists in the human stomach. Bacterial colonization of the digestive tract is considered not only healthy, but essential for survival. This is similar to the bacterial colonization that exists on our skin, which is also healthy and protective.

However, about 25 years ago, a physician discovered a link between H. pylori infections and peptic ulcers (gastric and duodenal ulcers). It was then proven that treating H. pylori with antibiotics reduces and all but eliminates the recurrence of ulcers in the upper digestive tract, and that patients with H. pylori have a higher risk of gastric (stomach) cancer. Based on these findings, gastroenterologists began treating all patients found to have H. pylori in their stomachs.

Years after this discovery, it was theorized that H. pylori may in fact be a healthy bacteria. Gastroenterologists noticed that when H. pylori is eradicated, patients develop an increased incidence of acid reflux, stomach flues, weight gain, and are at higher risk for esophageal cancer, which indicates that the presence of H. pylori protects patients from these diseases. I have personally seen many patients develop new onset acid reflux after being treated for H. pylori.

The question of whether H. pylori should be treated as a harmful bacteria or left alone as a healthy bacteria remains controversial, and many gastroenterologists disagree on the matter. All agree that in the case of ulcer disease— as well as with a biopsy discovery of intestinal metaplasia, a pathologic diagnosis thought to be the first step to gastric cancer— H. pylori must be treated. The presence of H. pylori in the stomach can be found through a biopsy done during an upper endoscopy procedure, by breath-testing, or by a simple stool sample. However, only upper endoscopy with biopsy can identify intestinal metaplasia. Without intestinal metaplasia, it is highly unlikely that the presence of H. pylori will lead to gastric cancer.

In sum, H. pylori is generally felt to be a healthy bacteria that protects against a number of significant diseases. However, due to its link to gastric cancer and peptic ulcer disease, the decision of whether or not to treat helicobacter pylori should be jointly discussed between an educated patient and a gastroenterologist.


Written by: Steven D. Gronowitz, MD, FACG