Quick answer: Helicobacter pylori is a bacterium that lives in the stomach lining. Around half of the world's adults carry it and many have no symptoms, but it is linked with gastritis, ulcers and a higher long-term risk of stomach cancer, so current guidelines recommend that anyone who tests positive discusses eradication with their doctor. Breath and stool tests show active infection; a blood antibody test can stay positive after the bacterium has gone. Nutrition does not replace eradication, but it may support your stomach, digestion and microbiome before, during and after it.
“H. pylori positive” is one of the results people most often bring to me with a mix of relief and confusion: relief that there is finally an explanation for the burning, the nausea or the fullness, and confusion about what to do next. If your symptoms sit mainly in the upper abdomen, it is also worth reading about feeling full quickly after eating and reflux and heartburn, because these often overlap.
What does it mean if you test positive for H. pylori?
It means the bacterium Helicobacter pylori has been found in your stomach (or, with a blood test, that your immune system has met it at some point). H. pylori is extremely common – a large meta-analysis estimated that roughly 4.4 billion people carried it in 2015, with higher rates in southern and eastern Europe than in northern Europe.2
It is usually picked up in childhood and can live quietly in the stomach for decades. In some people it causes chronic inflammation of the stomach lining (gastritis), which can lead to ulcers, and over many years it is a recognised risk factor for stomach cancer. That is why the Maastricht VI/Florence consensus recommends that infected people are offered eradication, even if they feel fine.1
What are the symptoms of H. pylori?
Many people have none. When symptoms appear, they are usually in the upper abdomen and are commonly associated with:
- burning or gnawing discomfort under the breastbone or in the upper tummy
- feeling full after only a few mouthfuls, or heavy for hours after meals
- nausea, belching and upper bloating
- reduced appetite
- tiredness linked to low iron or low B12
None of these symptoms is specific to H. pylori – the same picture is seen with functional dyspepsia, reflux, gallbladder problems and medication side effects, which is why testing matters more than guessing.
Which H. pylori test is most reliable?
There are three main options, and they answer slightly different questions:
- Urea breath test – shows active infection and is widely used.
- Stool antigen test – also shows active infection; this is the one people often see on a broader stool panel.
- Blood antibody test (serology) – shows exposure, not necessarily current infection. It can remain positive for months or years after the bacterium has gone.
Acid-suppressing medicines (PPIs such as omeprazole), recent antibiotics and bismuth can cause false negatives on breath and stool tests, so guidelines recommend a gap before testing – your doctor or pharmacist will tell you how long.1 If your only positive result is a blood test, ask your doctor whether a breath or stool test is needed to confirm active infection.
When to see your doctor first
- Black, tarry stools or vomiting blood (seek urgent care)
- Unintended weight loss, difficulty swallowing or persistent vomiting
- New indigestion over the age of 55, or a family history of stomach cancer
- Iron deficiency anaemia without an obvious cause
- Severe or worsening upper abdominal pain
Does H. pylori always need eradication therapy?
Current European guidance is that, once active infection is confirmed, eradication should be offered.1 This is done with a combination of medicines chosen by your doctor, usually for 10–14 days, followed by a re-test at least four weeks later to make sure it has gone. Antibiotic resistance is increasing, so the exact combination depends on local resistance patterns and your history.
This is firmly a medical decision. Herbal “H. pylori protocols” bought online are not a substitute, and delaying eradication while trying them is not something I recommend.
Can H. pylori cause bloating, low iron or other symptoms beyond the stomach?
Upper bloating, belching and early fullness are common. Beyond the stomach, H. pylori is consistently associated with iron deficiency: a meta-analysis found a significantly higher rate of iron deficiency anaemia in infected people.5 The likely reasons include less stomach acid (which iron needs to be absorbed well) and small, slow blood losses from an inflamed lining. Long-standing gastritis may also reduce B12 absorption.
If you have low ferritin that keeps coming back despite supplements, it is reasonable to ask your doctor whether H. pylori (and coeliac disease) have been checked.
How can nutrition support your gut before and after eradication?
This is where nutritional therapy may help, alongside – never instead of – your doctor's plan:
- During eradication: smaller, simpler meals, cooked vegetables and adequate protein are often better tolerated when nausea or a metallic taste kick in.
- Probiotics (optional): a meta-analysis found that adding the yeast Saccharomyces boulardii to standard therapy was associated with modestly higher eradication rates and fewer side effects, particularly diarrhoea.3 Whether it suits you depends on your history and other medicines, so it should be individualised and agreed with your doctor.
- Broccoli sprouts: a small human study found that sulforaphane-rich broccoli sprouts reduced markers of H. pylori colonisation and stomach inflammation, without eradicating it.4 They are a reasonable food to include, not an alternative to eradication.
- After eradication: the microbiome usually needs time to settle. Gradually reintroducing a variety of plant foods, fibre and (if tolerated) fermented foods supports that process – see how to support your gut after antibiotics.
- Nutrient status: work with your doctor to recheck iron, ferritin and B12 if they were low.
Eradicated, but still not right?
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Book your free 15-minute call →Why do some people still have symptoms after H. pylori is gone?
Successful eradication does not always mean instant relief. The stomach lining may take time to recover, and other contributors – reflux, functional dyspepsia, slow stomach emptying, low digestive enzyme output, SIBO or stress – may have been there all along. A root-cause approach looks at the whole digestive chain rather than one bacterium.
Frequently asked questions
Is H. pylori contagious?
It spreads mainly within families, usually in childhood, through saliva and possibly contaminated food or water. Adult-to-adult transmission seems less common. Ask your doctor whether household members should be tested.
Can I get rid of H. pylori naturally?
There is no good evidence that diet or supplements alone reliably eradicate H. pylori. Some foods and probiotics may support the stomach and reduce side effects, but eradication should be guided by your doctor.
Should I take probiotics with H. pylori antibiotics?
Some studies suggest that Saccharomyces boulardii may reduce side effects such as diarrhoea and modestly improve eradication rates. It is optional and should be individualised and agreed with your doctor.
Can H. pylori come back after eradication?
Reinfection in adults is relatively uncommon in Europe, but eradication can fail, often because of antibiotic resistance. That is why a confirmation test at least four weeks after finishing therapy is recommended.
What should I eat if I have H. pylori?
There is no single H. pylori diet. Simple, regular meals, cooked vegetables, adequate protein and limiting alcohol and smoking are commonly helpful for comfort. Broccoli sprouts are a reasonable addition, not a replacement for eradication.
References
- Malfertheiner P, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022. PubMed: PMID 35944925
- Hooi JKY, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017. PubMed: PMID 28456631
- Szajewska H, et al. Systematic review with meta-analysis: Saccharomyces boulardii supplementation and eradication of Helicobacter pylori infection. Aliment Pharmacol Ther. 2015. PubMed: PMID 25898944
- Yanaka A, et al. Dietary sulforaphane-rich broccoli sprouts reduce colonization and attenuate gastritis in Helicobacter pylori-infected mice and humans. Cancer Prev Res. 2009. PubMed: PMID 19349290
- Hudak L, et al. An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter. 2017. PubMed: PMID 27411077
This article is for educational purposes and is not medical advice. Nutritional therapy does not replace medical care. Always work with your doctor for any persistent or new symptoms and before making changes to your care, medication or supplements.