Gastritis and H. pylori — Testing, Eradication and Confirmation

Gastritis is inflammation of the stomach lining. Helicobacter pylori (H. pylori) is a common bacterial cause that can also cause peptic ulcers and increase stomach-cancer risk. Testing uses a stool antigen test, a urea breath test or biopsies taken during gastroscopy. Treatment combines acid-suppressing medicine with antibiotics, followed by a test to confirm the infection has cleared. Dr Goutham Sivasuthan provides diagnostic gastroscopy and post-treatment assessment across Brisbane, Redland and Logan.

What are gastritis and H. pylori?

Gastritis is inflammation of the stomach lining. Causes include H. pylori infection, anti-inflammatory medicines (NSAIDs), alcohol, autoimmune disease, bile reflux and severe physical stress. H. pylori lives in the stomach’s mucus layer. It is often acquired in childhood, although adults can also acquire it. Untreated infection can persist and cause ulcers; it is also associated with stomach cancer and a rare lymphoma called gastric MALT lymphoma.

Symptoms

Most people with H. pylori have no symptoms. When symptoms occur:

• Upper abdominal pain or burning (dyspepsia), often relieved by food or antacids
• Nausea
• Early satiety, bloating
• Loss of appetite, weight loss
• Symptoms of a peptic ulcer — gnawing epigastric pain, sometimes radiating to the back
• Vomiting blood (haematemesis) or passing black tarry stool (melaena) if a bleeding ulcer develops — seek urgent care

Risk factors and complications

• Birth in or family origin from regions with high H. pylori prevalence (most of Asia, the Middle East, South America, Eastern Europe, Indigenous Australian communities)
• Overcrowded household in childhood
• Long-term NSAID or aspirin use (independent risk for gastritis and ulcer)
• Smoking, heavy alcohol intake
• Complications: peptic ulcer disease, GI bleeding, gastric outlet obstruction, gastric MALT lymphoma, gastric cancer (the strongest known modifiable risk factor for gastric cancer)

How are gastritis and H. pylori diagnosed?

• Stool antigen test — non-invasive, accurate, and the first-line test in most uncomplicated cases
• Urea breath test (UBT) — non-invasive, equally accurate
• Gastroscopy with biopsy — the test of choice when an ulcer is suspected, in patients over 50 with new dyspepsia, in patients with alarm features (weight loss, anaemia, dysphagia, vomiting, family history of gastric cancer), or to assess for atrophic change or premalignant lesions
• Serology (blood antibody test) — not recommended in Australia because it cannot distinguish current from past infection

PPIs (acid-suppressing medicines) and antibiotics can cause falsely negative stool and breath test results. Testing is usually done at least 2 weeks after stopping a PPI and at least 4 weeks after finishing antibiotics. Your test instructions set out any medicine changes and when to make them; do not stop a prescribed medicine unless your treating clinician advises it.

How are gastritis and H. pylori treated?

For confirmed H. pylori infection, treatment uses a prescribed combination of medicines:

• Treatment combines acid-suppressing medicine with antibiotics. The prescription and course length are chosen for your circumstances.
• Before treatment, provide details of medicine allergies, previous antibiotic courses and your current medicines so the prescription can take these into account.
• If infection persists, the follow-up test result helps guide the next treatment course.

A follow-up stool antigen or urea breath test checks whether treatment has cleared H. pylori, even if your symptoms have settled. It is usually done at least 4 weeks after finishing antibiotics, and your test instructions explain any temporary medicine changes. Continue prescribed acid-suppressing medicine until your treating clinician advises a change.

For gastritis linked to an anti-inflammatory medicine (NSAID), treatment includes reviewing that medicine and whether stomach protection is needed. Changes to aspirin or another prescribed medicine should be agreed with your prescriber. Autoimmune gastritis can require vitamin B12 replacement and monitoring for gastric neuroendocrine tumours, with stomach-cancer surveillance in selected cases.

When to see a specialist

• New upper abdominal pain in someone over 50
• Any alarm feature: weight loss, anaemia, melaena or haematemesis, vomiting, difficulty swallowing, palpable mass
• Family history of gastric cancer
• Symptoms not responding to a standard PPI trial
• Failed first-line H. pylori eradication
• Atrophic gastritis or intestinal metaplasia on biopsy — for surveillance planning

What to expect at your appointment with Dr Goutham

Dr Goutham reviews your symptoms, previous results, family history and medicines to decide whether gastroscopy is appropriate. During gastroscopy, biopsies can be taken to test for H. pylori. Your GP receives the procedure report on the day, with biopsy results following separately. If infection is confirmed, Dr Goutham or your GP prescribes treatment and arranges follow-up testing to check that it has cleared.

Frequently asked questions

Did I catch H. pylori from food or water?

H. pylori is often acquired in childhood, although adults can also acquire it. A positive test identifies the infection; it cannot tell when or where it was acquired.

If I have H. pylori, do my family members need testing?

Routine family testing is not currently recommended in Australia. However, household members with persistent dyspepsia, a family history of gastric cancer, or other risk factors should discuss testing with their GP.

Why do I need a follow-up test if my symptoms resolved?

Because symptoms settling does not confirm that H. pylori has cleared. Follow-up testing checks that the infection has gone, even when you feel better. If infection remains, the result guides further treatment.

Book a consultation

Phone 07 3733 1551 or send a referral via the contact form. See about Dr Goutham or the cost page.