H. pylori and Chronic Gastritis: The Infection Behind Many "Acidity" Problems

Medically reviewed by Dr Murlidhar Boob — MS, FAIS, DLS, FMAS, Laparoscopic Surgeon & Surgical Gastroenterologist, Shubham Hi-Tech Hospital & Test Tube Baby Centre, Amravati.

Many people walk into my clinic and say the same thing: “Doctor, I have acidity.” They have had it for months, sometimes years. A burning or gnawing feeling in the upper stomach, a bloated tummy after meals, a little nausea in the morning. They have tried antacids, a gel from the chemist, a change of diet. It helps for a day and then it comes back.

When the pattern looks like that, one of the first things I think about is not acid at all. It is a small spiral-shaped bacterium called Helicobacter pylori, or H. pylori, living in the lining of the stomach.

What H. pylori actually does

This bacterium is remarkably well adapted. It survives in the stomach’s acidic environment by making a chemical that neutralises acid around itself, and then it settles into the mucus layer that protects the stomach wall. Over time it irritates that wall. The result is chronic gastritis, which simply means long-standing inflammation of the stomach lining.

For many people the infection stays quiet for life. For others it causes the vague, nagging symptoms above. In some it goes further and leads to a stomach or duodenal ulcer. And after many years, long-standing infection is also linked to a higher risk of stomach cancer. I mention that last point not to frighten you, but because it is a good reason to take months of stomach trouble seriously. Most people with H. pylori do not develop cancer, and treating the infection lowers the risk further.

It is common across the world, and it is thought to spread mostly through contaminated food and water or close contact, often in childhood. Having it says nothing about how clean you are or what you eat.

Is it acidity, reflux, or H. pylori?

These get mixed up constantly. If your main complaint is a burning that rises into the chest and throat, especially when you lie down, that is more likely reflux, and I have written about it in When Heartburn Isn’t Just Heartburn. H. pylori more often shows up as discomfort in the upper stomach itself.

A quick self-check. The following make H. pylori more worth testing for:

• Burning, gnawing or aching pain in the upper middle abdomen that comes and goes for weeks or months
• Feeling full after just a few bites, or bloated through the day
• Nausea or frequent belching without an obvious food trigger
• Pain that eases briefly after eating or with an antacid, then returns
• A family history of stomach ulcers or stomach cancer

“Doctor, I eat a lot of spicy food. Isn’t that the real cause?”

Spice can irritate an already inflamed stomach, so cutting back often makes you feel more comfortable. But chilli does not create the infection. Plenty of people who eat very mild food have H. pylori, and plenty who love spice do not. Fixing the diet alone will not remove the bacteria.

Red flags: don’t wait for these

Please see a doctor promptly, rather than treating yourself, if you notice:

• Black, tarry stools, or vomiting blood
• Unexplained weight loss
• Trouble or pain on swallowing
• Persistent vomiting
• Tiredness or paleness that could mean anaemia
• New stomach symptoms starting later in life

These do not always mean something serious. They are the signs that call for a proper look, usually with an endoscopy.

How we find it

Testing is simpler than most people expect. There are three common ways:

1. Stool antigen test. A small stool sample checks for the bacterium’s proteins.
2. Urea breath test. You swallow a harmless test solution and breathe into a bag. It is painless and quick.
3. Biopsy during endoscopy. If an endoscopy is advised anyway, for example because of a red flag, a tiny sample of the stomach lining can be tested at the same time.

A blood antibody test is cheap and easy, but it shows only that you have met the bacterium at some point, not that you carry it now, so we rarely rely on it.

One practical tip that saves a lot of repeat testing: acid-reducing tablets and recent antibiotics can give a falsely negative result. Doctors usually ask you to stop acid-reducing medicines for about two weeks, and to be free of antibiotics for about four weeks, before a breath or stool test. Please do not stop a medicine on your own though. Ask first.

What to expect at your appointment

Most of the visit is a conversation: how long, what it feels like, what helps, which medicines you have been taking, and whether anyone in your family has had stomach ulcers or cancer. We then decide whether you need a test alone or an endoscopy as well. The test results are usually straightforward, and if H. pylori is found, we explain the plan before you leave.

Clearing the infection

Treatment is a short, focused course. It combines an acid-reducing medicine with two or more antibiotics, taken together for around two weeks. Some people need a different combination because bacteria in India and elsewhere can resist common antibiotics, so the choice is tailored. You may notice a metallic taste, loose stools or mild nausea during the course. Tell us if it is troubling you, and do not simply stop.

“I feel fine after three days. Can I stop?”

I understand the temptation, but no. Feeling better early is common, and the bacteria are far from gone. Cutting the course short is the main reason treatment fails and the bacteria come back stronger. Finish all of it.

About four weeks after you finish, we repeat a breath or stool test to confirm the infection has cleared. That last step is the one people skip, and it matters.

A fair word on myths

Myth: “Acidity means I should keep neutralising acid forever.” Fact: If bacteria are driving your gastritis, removing them is the real fix, and the daily antacid habit can usually be left behind.

Myth: “Everyone with H. pylori needs surgery.” Fact: Almost nobody does. Treatment is medicines. Surgery is kept for rare complications such as a bleeding or perforated ulcer.

Don’t normalise months of stomach trouble

A stomach that has been unsettled for months is telling you something. It is very often treatable in two weeks of tablets once the cause is named. If this sounds like you, the team at Shubham Hi-Tech Hospital & Test Tube Baby Centre in Amravati will be glad to help you find out. You can call +91-8668954915 or contact us here. To see the wider range of conditions our surgical and gastroenterology team treats, visit our general surgery and gastroenterology page.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.