Helicobacter Pylori (H. pylori)

Unlike most bacteria, H. pylori can survive the harsh, acidic environment of the stomach by producing an enzyme called urease, which neutralises stomach acid in its immediate vicinity.

Once established, the bacteria can:

• Inflame the stomach lining: This is known as gastritis.

• Cause peptic ulcers: By breaking down the protective mucus layer, the bacteria allow stomach acid to create open sores in the lining of the stomach or the duodenum (the start of the small intestine). Certain pain relief medicines called NSAIDS, such as aspirin, ibuprofen, and naproxen, can also cause ulcers. Peptic ulcers are also more common if you smoke. 

• Long-term infection with H. pylori can increase the risk of developing stomach cancer.

In Aotearoa New Zealand, H. pylori is less common than in many other countries. On average, about 1 in 5 people have the infection.

However, your risk of having the bacteria depends a lot on your background. It is much more common in some communities than others. Māori, Pacific peoples and Asians have higher risk compared to New Zealand Europeans.

Many patients are asymptomatic. However, when the bacteria cause inflammation or an ulcer, symptoms may include:

• A dull or burning pain in the upper abdomen (often worse when the stomach is empty).

• Frequent burping or bloating.

• Nausea or a loss of appetite.

• Unexplained weight loss.

Currently, there are two main methods to diagnose H. pylori infection in Christchurch.

• Faecal Antigen Test: A stool sample is analysed to look for proteins associated with the bacteria.

• Gastroscopy & Biopsy: During a gastroscopy, a small tissue sample (biopsy) is obtained, to be examined under the microscope or tested for the urease enzyme (CLO test).

Important: To ensure an accurate result, you must stop taking Proton Pump Inhibitors (PPIs) like Omeprazole for at least 2 weeks, and Antibiotics for at least 4 weeks, prior to testing.

In New Zealand, H. pylori is typically treated with a combination of medications taken over 7 to 14 days. This is often referred to as "Triple Therapy":

1. A Proton Pump Inhibitor (PPI): To reduce stomach acid and allow the lining to heal.

2. Two Different Antibiotics: Usually a combination of Clarithromycin and Amoxicillin (or Metronidazole) to kill the bacteria.

Re-testing for clearance

It is essential to confirm that the infection has been completely eradicated. Generally, a faecal antigen test is arranged at least 4 to 6 weeks after you finish your course of antibiotics to ensure the treatment was successful.

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