H. pylori cases are decreasing worldwide, while ulcerative colitis numbers are increasing. There’s an increased interest in whether H. pylori might play a role, but the current research is inconclusive.

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). It’s a progressive condition that doesn’t currently have a cure, although treatment can help reduce symptoms.

As researchers continue to investigate possible short-term and long-term treatments for UC, there’s also a growing interest in the role Helicobacter pylori (H. pylori) might have in UC development and management.

H. pylori is a type of bacteria that can grow in your stomach. It’s relatively common and can easily survive gastric acids as it attaches to the stomach lining and multiplies. It also increases the risk of infections and chronic inflammation.

Due to its potential to alter immune responses, H. pylori is also linked with certain cancers and other chronic health conditions. On the other hand, complete eradication of the bacteria is also linked with gastrointestinal health issues.

So far, some of the findings may suggest that H. pylori bacteria could possibly reduce the incidence of UC development. Also, there’s interest in the possibility that a lack of these bacteria in the gut could increase the risk of UC more generally.

It’s important to keep in mind that this relationship is not yet fully understood. There’s also conflicting evidence over whether this bacterial infection may be harmful or helpful in IBD.

Read on to learn more about what the current research suggests about a possible link and what this might mean for UC treatment and management.

H. pyloriis primarily transmitted via contact with the feces of a person who has it, but the bacteria may also be spread orally. It’s estimated that two-thirds of people worldwide have H. pylori, but it’s mostly doesn’t cause symptoms.

While research shows that while H. pylori infection rates are decreasing on a global scale, the rate of UC is increasing. Any potential cause-and-effect isn’t well understood, but some researchers believe that the bacteria might offer a protective role against this type of IBD.

There’s no consensus around an inverse relationship between H. pylori infection and UC at this time, and the topic is controversial. Here is what the current research shows about the two conditions.

Higher rates of UC without H. pylori

According to one case-control study published in 2022, H. pyloriinfection rates were lower in adults with UC compared with a control group over the course of a year.

The researchers could not find a possible link between H. pyloriand UC development. Based on these findings, the authors hypothesized that the bacteria could possibly have a protective role against UC.

More long-term studies need to be conducted to determine whether the presence of H. pylori could decrease the risk of UC, and how much.

Treatment for H. pylori may decrease gut health

While an H. pyloriinfection may require treatment, antibiotics typically used in the treatment of this condition may increase your risk of gut flora imbalances and antibiotic resistance. Research suggests that altered gut microbiota may be linked with gastric problems.

A case report published in 2021 detailed an example of a 72-year-old female who developed UC after H. pylori eradication. UC was diagnosed 3 years after treatment.

Similarly, another 2021 study detailed a child with UC who later developed an H. pylori infection, only to experience worsening symptoms of UC after eradication of the infection.

More research is needed to determine whether this is a common occurrence.

H. pylori and UC severity

Another facet of the potential connections between H. pylori and UC involves the severity of the UC.

Researchers of a 2023 study determined that study participants with UC who also had H. pylori had lower rates of intestinal perforation and bleeding. There were also lower rates of hospitalization and overall mortality.

The exact role that H. pylori might play in decreased UC severity isn’t clear, but it warrants further study.

H. pylori may cause dangerous infections and chronic inflammation in the stomach. This can increase the risk of certain medical conditions like stomach cancers or a thinning of the stomach lining (atrophic gastritis).

The bacteria is also linked to peptic ulcers. For this reason, anyone with peptic ulcers should be tested for H. pylori infection.

Due to these risks, H. pyloriis classified by the National Toxicology Program as a substance “known to be a human carcinogen.” Overall, H. pylori is considered among one of the most common types of chronic bacterial infections globally.

H. pylori infections are thought to pose a decreased risk of another type of cancer called esophageal adenocarcinoma, as well as gastroesophageal reflux disease (GERD).

Despite some research pointing to a theory that H. pylori might be protective against UC, other evidence suggests otherwise.

A 2024 clinical review discusses the long-held belief that chronic H. pylori infections could negatively impact the development of inflammatory bowel disease overall because of progressive immunological changes in the gut. The authors noted that the evidence is mixed. One possible variable could be the strain of H. pylori, with cytotoxin-associated antigen A (CagA)-positive strains more likely to offer protection against IBD.

One 2022 study on adults with UC who underwent colonoscopy found a high amount of H. pylori in the colon. The authors noted that participants had higher levels of inflammation, as well as more disease activity.

Another 2023 case study reported a rare instance of a severe H. pylori infection in which UC was diagnosed first. The 23-year-old adult also had severe abdominal pain, bloody diarrhea, and nausea. He responded well to treatment for both conditions, including antibiotics.

Also, while more studies are needed to determine the role of H. pylori in UC development and progression, research suggests that both the infection and its subsequent eradication also have more negative implications in Crohn’s disease, another type of inflammatory bowel disease.

Until more is known about the relationship between H. pylori and UC, it’s important to continue your prescribed UC treatments. Among these include:

  • aminosalicylates
  • biologics
  • immunosuppressants
  • corticosteroids

Cases of asymptomatic H. pylori infections are sometimes left untreated because of the fear that antibiotics could do more harm than good. However, there’s no consensus on this point, with some experts believing the benefits of treatment outweigh the potential harm.

While the bacteria could potentially have a protective role, there’s also a risk that chronic H. pylori could lead to more intestinal inflammation and damage.

Overall, the theory of an inverse relationship between H. pylori and UC remains controversial. Some experts believe H. pylori may protect against UC development, while others suggest the bacteria can make the autoimmune disease worse.

It’s best to speak with a doctor to determine whether you have this infection. A severe, chronic infection might require antibiotics, regardless of whether you have UC.