What the research says
Two different problems that can overlap
H. pylori infects the stomach lining and is a major cause of gastritis and peptic ulcers. Its symptoms, such as upper abdominal discomfort, fullness, nausea and belching, can overlap with reflux, so the two are easily confused.
A systematic review in the BMJ found that the prevalence of H. pylori was lower in people with GORD than in those without, particularly in some regions, suggesting the relationship is not a simple cause-and-effect one.[1][2]
What the consensus recommends
The Maastricht VI/Florence consensus supports a “test-and-treat” strategy for H. pylori in people with dyspepsia, and eradication where infection is found. It concludes that eradication does not generally cause new reflux disease or worsen existing reflux, and should not be withheld because of reflux concerns. Testing and treatment are arranged by your doctor.[1]
Ongoing symptoms after eradication
Some people continue to experience bloating, reflux or indigestion after successful H. pylori treatment. Contributing factors can include pre-existing reflux, altered gut function, and dietary triggers, which is where a gut-health and dietary review can help.[3][4]
Douglas’s clinical observations
Practice experience from 65,000+ consultations since 1990, not research findings. Individual results vary.
Douglas regularly sees patients who have completed H. pylori treatment with their doctor but still have bloating, belching and reflux. In his experience, a gut recovery approach, which means identifying ongoing food triggers, reducing fermentation and supporting the gut as it settles, often helps these patients feel more comfortable.
He does not test for or treat H. pylori; that remains with the patient’s GP or gastroenterologist. His role is the dietary and gut-health support around it.
Key takeaways
- H. pylori mainly causes gastritis, ulcers and dyspepsia, not classic reflux.
- Consensus supports testing and treating H. pylori when indicated.
- Ongoing symptoms after eradication can benefit from dietary and gut-health support.
Educational information only. Douglas is a Clinical Nutritionist and does not diagnose medical conditions or advise on prescribed medication. Never stop or change medication without your doctor. Seek prompt medical care for difficulty swallowing, weight loss, vomiting, bleeding or chest pain (call 000 in an emergency). Red-flag symptoms
References
- 1.Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–62. (Consensus statement) View source
- 2.Raghunath A, Hungin AP, Wooff D, Childs S. Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ. 2003;326(7392):737. (Systematic review) View source
- 3.Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol. 2021;19(2):219–31. (Review) View source
- 4.Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27–56. (Clinical guideline) View source
Written by
Douglas Mizzi, Clinical Nutritionist
ATMS member #8079 · In practice since 1990 · 65,000+ consultations
Douglas specialises in diet, fermentation, gut health and gut recovery. He is a nutritionist, not a medical practitioner: he does not diagnose medical conditions or prescribe or change medication. Clinical observations in these articles reflect his practice experience and are presented separately from the published research. About Douglas