The symptoms of H. pylori infection are difficult to define.
Practically any type of symptom between the nipples and the bellybutton
could be coming from the stomach and could be caused by H. pylori.
For many years doctors recognised that it was not possible to detect
which patients had ulcers, that is why diagnosis always requires
H. pylori is always associated with gastritis, an inflammation
of the stomach in which white cells infiltrate into the stomach
lining. It is believed that these white cells can in themselves
cause damage and ultimately lead to weakness in the stomach lining,
which is the cause of the ulcer. This process is explained elsewhere
on the Helicobacter Foundation web pages.
Because of the above, any stomach symptom could possibly be caused
by H. pylori. Heartburn is related to a leaky valve at the
lower oesophagus and the arrival of acid from the stomach into the
oesophagus. Thus, heartburn could be related to H. pylori
if some H. pylori patients produce excessive acid (this is
known to occur) or if H. pylori leads to some slowing of
emptying of the stomach acid (this sometimes occurs when the pylorus
valve at the bottom of the stomach is narrowed). Burping symptoms
are usually related to some problem at the lower oesophageal sphincter,
allied to heartburn, reflux and hiatus hernia. Since I believe patients
with H. pylori are more likely to vomit, I also think they
are more likely to damage their lower oesophageal sphincter over
the years and be more susceptible to symptoms such as burping. The
production of gas in the stomach comes from carbon dioxide seeping
through the stomach wall, and it is possible that H. pylori
can increase the amount of carbon dioxide present in the stomach
ie. causing burping. Patients who burp excessively however, are
often actually swallowing small amounts of air and burping it back
up to relieve a discomfort they have related to an oesophageal sphincter
problem, as discussed above. Burping can sometimes also occur when
the stomach is slow to empty and food in the stomach ferments, releasing
Symptoms of nausea associated with vomiting are quite likely to
be caused directly by a stomach condition and can be symptoms of
H. pylori infection. If the vomit is initially clear and
subsequently contains blood, it is likely to be caused by a tear
in the lower part of the oesophagus caused by the initial vomiting.
If blood is present in the vomiting, it can also be caused by a
bleeding ulcer in the stomach. The appearance of blood in vomit
is either red (a recent or large bleed) or dark brown (bleeding
in the last hour or so with changed blood affected by stomach acid).
Blood in the stomach can also appear black if it has been resting
in the stomach for a few hours. When bleeding occurs in the stomach
and blood comes in contact with stomach acid it is then changed
to a black colour, so that the patient with significant stomach
bleeding (more than 200 mls) is likely to have black stools, which
is called melena.
When H. pylori and gastritis cause delay in gastric emptying
patients may feel bloated or full after a normal sized meal ("early
The opposite can also occur in a few patients. For example, a patient
may state that after eating nutritious and tasty food they still
feel hungry ("as if the food has not done me any good").
I believe this symptom is associated with low acid secretion and
is also sometimes described by patients on acid lowering drugs.
Early satiety (fullness) can possibly also be caused just by the
inflammation of the lining of the stomach, since the stomach does
not easily expand as well as a healthy stomach, and the stomach
lining is rather sensitive to stretching.
Pain in the stomach and duodenum is often described as "gnawing",
which is somewhat hard to describe, but typically is a symptom of
severe hunger and nausea combined so that the patient with gnawing
is not sure whether he should vomit or eat! This symptom is typical
of duodenal ulcer patients who have gnawing when the stomach is
empty. The best cure is a very small, light snack or taking acid
Symptoms of gas and flatulence below the stomach are often hard
to cure. The causes of gas in the intestine are fermenting sugars,
and this can result from any kind of maldigestion of sugar, including
maldigestion of sugars that are not digestible ie. beans! Maldigestion
of milk sugar is called lactose intolerance. In patients with lactose
intolerance colicky pain, gassy symptoms and diarrhoea can sometimes
result after drinking milk. Patients who have a high fibre diet
may not tolerate it particularly well and sometimes complain of
distension and gas. In rare cases, bacterial colonisation of the
intestine can result in fermenting of sugars in food before the
food is absorbed. This also leads to gas symptoms.