Gastritis and H. pylori: What It Is, How It’s Treated, and What Really Works

When your stomach feels like it’s on fire-burning, bloated, or achy after eating-it’s easy to blame spicy food or stress. But if the discomfort sticks around, it might not be a passing upset. You could be dealing with gastritis, a real condition where the lining of your stomach becomes inflamed. And in most cases, it’s not just stress or diet. It’s a tiny bacterium called Helicobacter pylori-and it’s hiding in plain sight.

What Exactly Is Gastritis?

Gastritis isn’t one single disease. It’s a group of conditions where the stomach’s protective lining gets irritated or damaged. Think of it like a sunburn, but inside your stomach. That lining normally shields your stomach wall from the strong acid and enzymes it uses to digest food. When it breaks down, acid starts eating away at the tissue, causing pain, nausea, and sometimes bleeding.

There are two main types: erosive and nonerosive. Erosive gastritis means there are actual sores or breaks in the lining-you might see blood in your vomit or black, tarry stools. Nonerosive is sneakier. The lining is inflamed, but nothing’s visibly torn. This type often comes with no symptoms at all. About half of people with chronic gastritis don’t even know they have it until something worse happens.

The biggest culprit? Helicobacter pylori. This spiral-shaped bacteria lives in the stomach of nearly half the world’s population. In the UK and US, about 1 in 5 adults carry it. But here’s the twist: most never get sick. Only 10-20% of infected people develop ulcers or gastritis. Why? It depends on the strain, your immune system, and how long you’ve had it.

How Do You Know If It’s H. pylori?

If you’ve had ongoing stomach pain, bloating, or nausea for weeks, your doctor won’t just guess. They’ll test for H. pylori. The gold standard is an endoscopy-where a thin camera goes down your throat to look at your stomach and take tiny tissue samples. If the biopsy shows the bacteria, that’s confirmation.

But not everyone needs a scope. Non-invasive tests work well too. The urea breath test is simple: you drink a special liquid, then blow into a bag. If H. pylori is present, it breaks down the liquid and releases carbon dioxide you can detect. Blood tests can show past exposure, but they can’t tell if the infection is still active. Stool tests look for bacterial proteins and are very accurate.

The key is timing. If you’ve been on acid-reducing meds like omeprazole, those can mask the infection. Your doctor will usually ask you to stop them for a week or two before testing.

How Is H. pylori Treated?

Treating H. pylori isn’t like taking an antibiotic for a sore throat. It’s a three-drug combo, taken for 10 to 14 days. This is called triple therapy: a proton pump inhibitor (PPI) like omeprazole or esomeprazole, plus two antibiotics-usually amoxicillin and clarithromycin.

The goal isn’t just to feel better. It’s to kill the bacteria completely. If even one bug survives, it can come back stronger-and resistant. That’s why adherence matters. Missing doses is one of the top reasons treatment fails.

Success rates? Around 80-90% in places where clarithromycin resistance is low. But in the UK and US, resistance has jumped from 10% in 2000 to over 35% today. That means many first-line treatments now fail. When that happens, doctors switch to quadruple therapy: a PPI, bismuth subsalicylate (like Pepto-Bismol), plus two antibiotics-metronidazole and tetracycline. This works in 85-92% of cases, even when clarithromycin doesn’t.

A newer drug, vonoprazan, has been approved in the US since 2022 and is gaining traction in Europe. It’s not an antibiotic-it’s a potassium-competitive acid blocker. It shuts down stomach acid more completely than PPIs. In trials, it cleared H. pylori in over 90% of patients, even after two failed treatments.

What About Side Effects?

The antibiotics are tough. About 6 in 10 people report nausea, diarrhea, or a metallic taste during treatment. Some can’t finish the course. That’s why doctors often prescribe anti-nausea meds like domperidone alongside the antibiotics. Probiotics-especially Lactobacillus and Saccharomyces boulardii-can help reduce side effects and improve success rates by 10-15%.

PPIs are generally safe short-term, but long-term use (over a year) carries risks: lower magnesium, higher chance of bone fractures, and rebound acid reflux when you stop. That’s why treatment is time-limited. After finishing antibiotics, you usually stop the PPI after 4-8 weeks unless you still have symptoms.

What If It’s Not H. pylori?

Not all gastritis comes from bacteria. NSAIDs like ibuprofen or aspirin cause about 25-30% of cases. If you’ve been taking them daily for joint pain or headaches, your stomach lining is under constant attack. Stopping them is the first step. If you can’t stop them, your doctor might switch you to a safer painkiller like paracetamol and give you a PPI for protection.

Autoimmune gastritis is rare-only 0.1% of people have it-but it’s serious. Your immune system attacks the cells that make stomach acid and intrinsic factor (needed for B12 absorption). People with this type often develop pernicious anemia. They need lifelong B12 injections, not antibiotics.

Alcohol, stress, and bile reflux can also trigger gastritis. Heavy drinking (more than 30g a day-about two pints of beer) doubles your risk. Cutting back cuts symptoms by 60% within two weeks.

What Happens If You Don’t Treat It?

Left untreated, chronic gastritis doesn’t just cause discomfort. It can lead to ulcers, bleeding, or even stomach cancer. H. pylori infection increases cancer risk by 6-8 times. But here’s the good news: treating it cuts that risk by half. The World Health Organization classifies H. pylori as a Group 1 carcinogen-same as smoking.

That’s why experts now recommend testing and treating H. pylori in people with a family history of gastric cancer, or those from high-risk areas like Eastern Europe or East Asia. In the UK, testing is usually offered if you have persistent symptoms or a history of ulcers.

What Can You Do at Home?

Medication does the heavy lifting, but lifestyle changes help you heal faster and stay healthy.

• Stop smoking. It slows healing by 35%.
• Avoid alcohol. Even moderate intake irritates the lining.
• Eat smaller meals. Large meals stretch the stomach and increase acid pressure.
• Limit spicy, acidic, or fried foods. They won’t cause gastritis, but they can make symptoms worse.
• Manage stress. While stress doesn’t cause gastritis, it can make symptoms feel worse.

There’s no magic diet for gastritis. But many people find relief by avoiding trigger foods-coffee, citrus, chocolate, and carbonated drinks are common offenders.

How Long Until You Feel Better?

Symptoms often improve within a few days of starting treatment. Pain and nausea usually ease in 3-7 days. But feeling better doesn’t mean you’re cured. The bacteria might still be there.

You’ll need a follow-up test-usually a breath or stool test-4 weeks after finishing antibiotics. This confirms the infection is gone. If it’s still positive, you’ll need a second-line treatment.

What About Rebound Acid?

Many people stop their PPI after treatment and suddenly feel worse than before. That’s rebound acid hypersecretion. Your stomach overcompensates for the lack of acid suppression. It’s not a relapse-it’s a side effect of stopping too fast.

To avoid it, taper off PPIs slowly. Instead of stopping cold, reduce the dose over 2-4 weeks. Talk to your doctor about a plan. Some people need to stay on a low dose for months.

When Should You Worry?

See a doctor right away if you have:

• Black, tarry stools (sign of bleeding)
• Vomiting blood or material that looks like coffee grounds
• Unexplained weight loss
• Difficulty swallowing
• Severe, persistent pain that doesn’t improve

These aren’t normal. They could mean an ulcer, bleeding, or something more serious.

Final Thoughts: Is Treatment Worth It?

Yes. Even if you feel fine, treating H. pylori if you have it reduces your long-term risk of ulcers and cancer. It’s not about feeling better today-it’s about protecting your stomach for the next 20 years.

Most people who complete treatment never have gastritis again. Those who don’t? They’re the ones who end up back in the hospital with bleeding ulcers or worse.

Don’t ignore persistent stomach symptoms. Get tested. Treat it properly. And don’t stop your meds early-even if you feel fine. Your stomach will thank you.