Helicobacter pylori is a type of bacterium that lives in the stomach lining and is one of the most common causes of gastritis (inflammation of the stomach lining) and peptic ulcers. It can also lead to gastric cancer over time if left untreated (Malfertheiner et al., 2017).

H. pylori is usually spread through contaminated food, water, or unsanitary conditions, particularly in areas with poor sanitation. Once inside the stomach, it survives by neutralising stomach acid with an enzyme called urease, which allows it to thrive in the acidic environment. The bacterium attaches to the stomach lining and causes chronic inflammation, leading to symptoms such as stomach pain, bloating, nausea, and in severe cases, bleeding ulcers or gastric cancer (Feng & Xiao, 2011; Kusters et al., 2006).

While many people carry H. pylori without symptoms, in some individuals it can cause long-term damage to the stomach lining, leading to complications like ulcers and even stomach cancer if left untreated (Correa, 2013).

✔️ What it is: A bacterium that lives in the stomach lining and is the primary cause of gastritis, peptic ulcers, and is associated with stomach cancer (Correa, 2013).

✔️ How it spreads: Most commonly through contaminated food, water, or direct contact with an infected person. Poor sanitation and hygiene increase the risk (Kim et al., 2018).

✔️ Symptoms:

Peptic ulcers (stomach pain, indigestion, nausea, bloating, loss of appetite).

Gastritis (inflammation of the stomach lining, leading to stomach pain, vomiting, and nausea).

Can be asymptomatic in some people, meaning they carry the bacteria without showing symptoms.

✔️ Who’s most at risk: People in areas with poor sanitation, crowded living conditions, or those with a family history of stomach conditions.

✔️ Diagnosis: Blood tests, stool tests, breath tests, or endoscopy.

✔️ Treatment: A combination of antibiotics and proton pump inhibitors (PPIs) to kill the bacteria and reduce stomach acid, aiding healing (Malfertheiner et al., 2017).

✔️ Prevention:

Drink safe, clean water.

Wash hands thoroughly, especially before meals.

Avoid consuming unclean or undercooked food.

When Helicobacter pylori infects the stomach, the body’s innate immune system responds first. The stomach lining recognizes the bacteria, which triggers an inflammatory response. This leads to the release of chemical signals such as interleukin-8 (IL-8), which attract immune cells like neutrophils to the infection site (Malfertheiner et al., 2017). However, H. pylori is a very adaptable pathogen. It produces urease, an enzyme that helps it survive in the acidic stomach environment by neutralizing stomach acid around the bacteria. This enables it to evade some of the body’s initial defences and thrive in the stomach lining (Kim et al., 2018).

As the infection persists, the adaptive immune system gets involved. T helper cells (CD4+ T cells) and B cells play a critical role in responding to the bacteria. Th1 cells help activate macrophages to destroy infected cells, and B cells produce antibodies to target the bacteria (Kusters et al., 2006). However, H. pylori can evade these immune responses by altering its surface proteins, making it harder for the immune system to recognize and attack it effectively (Malfertheiner et al., 2017). In the long term, chronic inflammation caused by the immune response can lead to damage in the stomach lining, resulting in conditions like gastritis, peptic ulcers, and even stomach cancer (Correa, 2013).

Infection with Helicobacter pylori can lead to various digestive problems. The most common symptom is gastritis, an inflammation of the stomach lining, which can cause stomach pain, bloating, nausea, and loss of appetite (Malfertheiner et al., 2017). Many people also experience indigestion (dyspepsia) or a feeling of fullness after eating a small meal (Correa, 2013).

For some individuals, H. pylori can lead to peptic ulcers, where sores form in the stomach or upper part of the small intestine. Symptoms of ulcers include burning stomach pain, nausea, and vomiting—particularly after eating (Kim et al., 2018). In more severe cases, untreated H. pylori infection can lead to complications, such as internal bleeding or a perforated ulcer, which can cause intense pain and require immediate medical attention. Chronic infection with H. pylori can also increase the risk of gastric cancer over time, due to long-term inflammation in the stomach lining (Malfertheiner et al., 2017).

High prevalence rates

Helicobacter pylori is a common bacterial infection in South Africa, with prevalence rates ranging from 67.7% to 77.6% among adults (Emmanuel et al., 2024). This high prevalence is attributed to factors such as poor sanitation, overcrowding, and limited access to healthcare, which facilitate the transmission of the bacterium.

Gastrointestinal disorders

Infection with H. pylori is associated with various gastrointestinal disorders, including gastritis, peptic ulcers, and gastric cancer. While many individuals remain asymptomatic, approximately 10–20% of infected individuals develop these conditions (Moss et al., 2022). The bacterium’s ability to induce chronic inflammation in the stomach lining contributes to the development of these disorders.

Antibiotic resistance challenges

The treatment of H. pylori infection is complicated by rising antibiotic resistance (Setshedi, 2023). This resistance hampers the effectiveness of standard treatment regimens and underscores the need for antimicrobial susceptibility testing to guide therapy.

Eradication and prevention

Eradicating H. pylori is crucial to preventing the progression of gastric diseases. However, the high prevalence and antibiotic resistance present significant challenges to eradication efforts. Strategies to improve sanitation, health education, and antibiotic stewardship are essential to control the spread of H. pylori and reduce its impact on public health.

Helicobacter pylori is a bacterium that can cause gastritis, peptic ulcers, and in some cases, gastric cancer if left untreated. Strengthening the body’s gut defences can help prevent infection and manage symptoms (Malfertheiner et al., 2017).

Promote a healthy gut microbiome

A balanced microbiome in the gut is key to preventing H. pylori infection. Beneficial bacteria, like Lactobacillus and Bifidobacterium, help maintain the stomach’s protective lining and reduce inflammation. These bacteria also outcompete harmful microbes, preventing them from taking hold (Malfertheiner et al., 2017). Diets high in fibre, from foods like whole grains, fruits, and vegetables, support the growth of these beneficial bacteria (Makki et al., 2018). Probiotic-rich foods like yogurt, fermented vegetables, and kefir also support gut health and may help the body fight H. pylori infection (Feng & Xiao, 2011).

Eat gut-friendly foods

Antioxidant-rich foods such as berries, green leafy vegetables, and garlic support the immune system and may help reduce inflammation caused by H. pylori (Xu et al., 2015). Also, anti-inflammatory foods, such as turmeric, ginger, and olive oil, may help reduce the risk of ulcers and gastritis by soothing the gut lining and fighting infection (Shirley et al., 2018).

Hygiene and food safety

Preventing H. pylori infection involves good hygiene practices, especially because the bacteria is spread through contaminated food and water.

Wash hands thoroughly, especially after using the bathroom or before eating.

Drink clean, treated water or boil water in areas with poor sanitation.

Wash fruits and vegetables thoroughly before eating, and avoid consuming undercooked or raw foods in high-risk areas.

Treatment during infection

In case of infection, hydration is crucial, as diarrhoea and nausea can lead to dehydration. Medical treatment for H. pylori involves a combination of antibiotics and proton pump inhibitors (PPIs), which reduce stomach acid and promote healing of the stomach lining (Malfertheiner et al., 2017). These treatments are essential to prevent ulcers and the progression to more serious conditions, such as gastric cancer.