Your H. pylori test came back positive. What now?

Take a breath first

Seeing the word “positive” on a lab report is frightening, especially when a bacterium’s name sits next to it and you hear it is linked to cancer. But Helicobacter pylori is a common infection and it can be treated. ACG calls it the usual bacterial infection of the stomach worldwide and says most people who have it have no symptoms. A positive test means you now need to talk about “what do we do?”, not that something bad has happened.

What is H. pylori?

A bacterium that lives in the stomach. ACG writes that in some people it can cause an ulcer in the stomach or the first part of the intestine and raise the future risk of stomach cancer, and that it may spread by sharing food and drink with an infected person. NIDDK says that, together with certain painkillers, it is the most common cause of stomach ulcers. The NHS also says an untreated infection raises the risk of stomach cancer.

But “higher risk” is not the same as “you have cancer.” Risk means probability, not certainty, and ACG says most infected people have no symptoms at all. What you need is for your doctor to say, based on your situation.

What are the symptoms?

There may be none. If there are, NIDDK, describing stomach ulcers, lists: abdominal pain or discomfort, feeling full early or heavy after eating, nausea, bloating and belching. The NHS also mentions burning pain in the upper abdomen that gets worse at night, indigestion and nausea.

What are the tests?

ACG names four methods: a blood test for antibodies, a breath test, a stool test, and a stomach biopsy during endoscopy. The NHS also lists the breath, stool and blood tests, and sometimes endoscopy.

One practical point: some medicines and treatments can change the result of some tests. If you are going to be tested, show your doctor or the lab your list of medicines and ask whether you should watch out for anything before the test. Do not stop any medicine yourself; if it is needed, the doctor will tell you.

How is it treated?

NIDDK says treatment is a combination of several medicines, usually two or more antibiotics together with an acid-reducing medicine, and sometimes another medicine. ACG also says three or four medicines are usually needed, taken for about 10 to 15 days. The exact type and length are written by the doctor and depend on your age, history, allergies and other medicines. No drug names or amounts appear here, because you should not choose medicines yourself from an article.

A few important points:

• Finish the course. NIDDK says if you stop early, some bacteria survive and may become resistant. If side effects bother you, do not stop the medicine yourself; contact your doctor. A widespread rash, swelling of the lips or face, or shortness of breath is the exception: do not continue the medicine, and call 115. ACG also says side effects such as stomach upset, nausea or diarrhoea usually pass after treatment ends.
• Tell the doctor about past antibiotics. NIDDK says the doctor may rule out antibiotics you have taken before, because the bacteria may have become resistant to them.
• Do not take leftover or earlier antibiotics on your own. Every course should be on a doctor’s prescription and for this infection.

After treatment: test again

NIDDK says a repeat test should be done at least four weeks after the medicine is finished, to find out whether the bacteria are gone. ACG also mentions a breath test, a stool test, or endoscopy with a biopsy for follow-up. If the infection is still there, NIDDK says the doctor may prescribe a different combination. Do not lose heart; this happens in the treatment of this infection.

Should every positive result be treated?

This cannot be answered from an article. ACG considers treatment useful for healing the ulcer, lowering the chance of it coming back, and lowering the long-term risk of stomach cancer, but whether it is needed for you, given your situation and symptoms, is the doctor’s decision. Tell the doctor about any history of ulcers, any family history of stomach cancer, and the medicines you take.

Stomach ulcers and painkillers

NIDDK and the NHS both count certain anti-inflammatory painkillers among the main causes of stomach ulcers. If you take a painkiller on your own, without a prescription, talk to a doctor or pharmacist before carrying on. If a doctor prescribed it for another condition, do not stop or change it yourself, and tell them its name.

What role does food play?

NIDDK says diet does not cause, prevent or treat stomach ulcers and does not recommend a particular diet. The NHS suggests quitting smoking, cutting down on alcohol and managing stress. See the guide to food and daily habits.

When to get help right away

An ulcer can bleed. If you vomit blood or something that looks like coffee grounds, have black sticky stool, sudden severe abdominal pain, or sudden chest pain, do not wait for an appointment. The NHS treats these as emergencies. Read urgent warning signs and call 115 (Iran’s emergency number).

Summary

• A positive breath, stool or biopsy test means the infection is there, not that you have cancer. A positive blood test needs your doctor’s interpretation.
• Treatment is with medicines under a doctor’s supervision; finish the course.
• Have a confirmation test at least four weeks after treatment ends.
• Do not start, stop or change any medicine yourself.