· Lee Chee Cheow, M.Sc. Dip CMP · Digestive Health · 4 min read
Peptic Ulcers and H. Pylori: What You Need to Know
H. pylori infects more than half the global population and is linked to the vast majority of stomach cancers worldwide. Here's what it actually does, how common it is in this region, and what to watch for.
Among the causes of organic dyspepsia — indigestion with an identifiable underlying disease — peptic ulcers and the bacterium behind most of them, Helicobacter pylori (H. pylori), are among the most significant. Gastritis and peptic ulcers are estimated to account for 15–30% of organic dyspepsia cases on investigation, according to a systematic review and meta-analysis in Clinical Gastroenterology and Hepatology.
What a peptic ulcer actually is
A peptic ulcer is an open sore in the lining of the stomach (a gastric ulcer) or the upper part of the small intestine just past the stomach (a duodenal ulcer). Peptic ulcers are a common cause of upper abdominal pain and dyspepsia, and the most common symptom is burning stomach pain — typically made worse by stomach acid and by having an empty stomach.
The two major risk factors for developing a peptic ulcer are:
- H. pylori infection in the gastric or duodenal lining
- Regular or high-dose use of NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, naproxen, and ketoprofen
Why untreated ulcers matter
Left unaddressed, peptic ulcers can lead to serious complications:
- Bleeding — slow, gradual bleeding can lead to anaemia, while brisk bleeding can become a life-threatening haemorrhage
- Perforation — a full-thickness hole through the stomach or duodenal wall, which can cause peritonitis and sepsis if not treated promptly
- Obstruction — scarring or swelling around the ulcer can narrow the outlet of the stomach, leading to vomiting and weight loss
These are exactly the kind of “alarm features” that distinguish organic dyspepsia from the functional form, and why persistent or severe symptoms warrant proper medical evaluation rather than ongoing self-management.
Just how common is H. pylori infection?
H. pylori is strikingly common worldwide — present in more than half of the global population, according to a review in Nature Reviews Gastroenterology & Hepatology (2017). The bacterium usually establishes itself in the stomach during childhood and, if it persists, becomes a major cause of chronic gastritis and peptic ulcer disease later in life. Transmission is thought to occur mainly through close contact — saliva, vomit, or stool — and possibly through contaminated food or water.
Infection is not evenly distributed globally. East Asia carries by far the largest share of cases, at an estimated 53.8% of the global infected population, according to data reported in Cancers (2024). South Central Asia (11.3%), Eastern Europe (6.9%), South America (5.7%), and South-Eastern Asia (4.0%) follow at considerably lower shares.
The link to stomach cancer
This is the statistic that makes H. pylori worth taking seriously well beyond ulcer symptoms: H. pylori causes an estimated 90% of stomach cancers worldwide, roughly half of which occur in China alone. That regional concentration lines up closely with the infection prevalence data above.
It is worth being clear about what this actually means in practice — most people infected with H. pylori do not develop cancer. According to outcome data in the same Nature Reviews Gastroenterology & Hepatology review, the typical clinical progression looks like this:
| Outcome | Proportion of infected individuals |
|---|---|
| Asymptomatic or chronic gastritis | More than 80% |
| Chronic atrophic gastritis / intestinal metaplasia | 15–20% |
| Gastric or duodenal ulcer | 15–20% |
| Gastric cancer or MALT lymphoma | Less than 1% |
In other words, H. pylori infection is common and usually stays asymptomatic or limited to gastritis — but because it is such a strong risk factor at a population level, and because it is a treatable bacterial infection, testing and eradication (typically with antibiotic-based therapy) is a standard part of managing dyspepsia where H. pylori is suspected, particularly in regions with high infection rates like East Asia.
Frequently asked questions
Does having H. pylori mean I will get stomach cancer? No. More than 80% of people infected with H. pylori remain asymptomatic or develop only chronic gastritis; gastric cancer occurs in less than 1% of infected individuals. However, because H. pylori is responsible for the large majority of stomach cancers at a population level, testing and treatment where indicated is still worthwhile.
How is H. pylori infection usually treated? Standard care typically involves antibiotic-based eradication therapy, often combined with acid-suppressing medication, prescribed and monitored by a doctor.
What are the warning signs of a peptic ulcer that need urgent attention? Burning stomach pain that worsens with an empty stomach, vomiting blood, black or tarry stools, or unintentional weight loss all warrant prompt medical assessment.
This article is for general information only and does not constitute medical advice. If you have symptoms of a peptic ulcer or suspect H. pylori infection, consult your doctor for proper testing and treatment.