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Dr. Harsh J Shah

H. pylori Is Common in India. Why Do Few Get Ulcers?

Last updated: 27-Oct-2026

Dr Harsh Shah, GI surgeon, Ahmedabad

Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)

In short

H. pylori is a stomach germ carried by roughly half of all people, and by more in India. Most never get an ulcer, but it is the usual cause of one.

It is caught in childhood from family, so a test for one person often means testing the others at home. Acid tablets can hide it from a test.

Clear the germ with a full course of medicines. Then check that it has gone. This is what stops most ulcers from coming back.

The full care plan is on the peptic ulcer treatment in Ahmedabad page. This post explains how common the germ is, how it spreads, and who needs a test.

How common is H. pylori in India?

H. pylori is a stomach germ that infects roughly half of all people worldwide. It is more common in South Asia, so most adults in India have met it at some point.

  • The germ lives in the lining of the stomach and can stay there for decades.
  • Most people who carry it feel nothing at all.
  • Rates are higher where homes are crowded and clean water is hard to find.
  • Rates are falling in younger city families, but they remain high across India.

Because it is so common, having the germ does not mean you will get an ulcer. It means the germ is the first thing to look for if you do.

How the germ is caught

Most people catch H. pylori as small children, from close contact with family. Without treatment it usually stays for life, so an adult ulcer often traces back to childhood.

  • It passes from person to person through saliva, vomit or stool.
  • Sharing food, sharing a bed and crowded homes make spread easier.
  • Unclean water may also carry it.
  • Catching it as an adult is uncommon, so a child’s infection usually comes from a parent or sibling.

This is why one infected person in a home is a reason to ask about the others. Blame has no place here. It is an ordinary infection of crowded living, not a sign of poor hygiene by any one person.

Why most people never get an ulcer

Only a small share of infected people ever get an ulcer. Where the germ settles in the stomach, and how much acid you make, decide what follows.

Where the germ settles and what can follow
Where the germ mainly sitsAcid levelWhat can follow
Lower part of the stomachHighUlcer in the first part of the small bowel (duodenal ulcer)
Upper part or the whole stomachLowUlcer in the stomach itself, and thinning of the lining over many years
Spread evenly, with little inflammationNormalUsually nothing. The person never knows

Some strains of the germ cause more damage than others. Smoking, painkillers and a family history add to the risk. Long-standing infection can slowly thin the stomach lining, which is one reason doctors prefer to clear it early.

Why clearing the germ matters

If an ulcer is healed with acid tablets alone while the germ stays, the ulcer very often returns. Clearing the germ is what stops it coming back.

  • Acid tablets heal the sore but do not remove the cause.
  • A short course of medicines that kill the germ removes the cause.
  • After a successful course, a returning ulcer becomes uncommon.
  • This is why most ulcer operations of the past are no longer needed.

The key word is successful. A course that did not work is easy to miss, so a follow-up test is part of the treatment. If you have had a bleed or a hole, the next steps are in what happens after an ulcer bleed or hole.

Who should be tested

Test for H. pylori if you have had an ulcer or a long-standing upset stomach. Test also if a close relative has had stomach cancer. A doctor decides the rest.

Who is usually tested for H. pylori
Your situationWhat is usually done
Current or past ulcer, never treated for the germTest, and treat if positive
Younger person with an upset stomach and no warning signsBreath or stool test first, scope only if needed
Weight loss, trouble swallowing, vomiting, black stool or anaemiaScope first, without waiting for a test
Parent, brother or sister of someone with stomach cancerTest and treat if positive
Need for long-term aspirin or painkillers, especially after an ulcerTest before starting, and treat if positive
Anaemia that has no other causeTest after the usual checks

Warning signs always come first. They call for a scope, whatever your age. The signs of an ulcer and the tests that follow are laid out in stomach pain: is it an ulcer.

Tests, and the acid tablet trap

Acid tablets taken for weeks can make a breath or stool test read negative when the germ is still there. Tell your doctor about every acid tablet you take.

Common tests for H. pylori
TestWhat it showsThe catch
Breath testGerm is present nowAcid tablets and antibiotics can hide it
Stool testGerm is present nowSame catch as the breath test
Sample taken during a scopeGerm present, and the state of the liningLess reliable during a bleed or on acid tablets
Blood antibody testYou have met the germ at some timeCannot tell old from current, so it cannot show the germ is gone

Many people in India buy acid tablets over the counter for months. If that is you, your doctor may ask you to stop them for about two weeks before a breath or stool test. This is done only when it is safe. Do not stop them on your own if you have bled.

Why the usual tablets now fail more often

The germ has grown resistant to some common antibiotics, mainly through repeated, half-finished courses. A single old-style course now fails more often than it used to.

  • Resistance to some antibiotics is high in South Asia.
  • Courses are therefore chosen with local resistance in mind.
  • Many people now need four medicines taken together for about two weeks.
  • Finishing the whole course matters. Stopping early breeds resistance.

A test at least four weeks after the course shows whether it worked. If the germ is still there, a different set of medicines is used.

Not every ulcer is H. pylori

Painkillers and aspirin cause many ulcers, with or without the germ. A negative H. pylori test does not close the question, so every medicine you take has to be reviewed.

  • Painkillers such as diclofenac and ibuprofen can injure the stomach lining.
  • Herbal powders and balms sometimes contain painkillers.
  • A few ulcers have other causes, and these need a doctor to look for them.
  • A stomach ulcer that does not heal needs a repeat scope with samples.

For ulcers that bled, the first treatment is described in how a scope stops the bleed. A hole in the wall is covered in perforated peptic ulcer surgery.

Questions to ask your doctor

  • Do I need a test for H. pylori, and which one suits me?
  • Should I stop my acid tablets before the test, and for how long?
  • Which medicines will I take, for how many days, and what are the side effects?
  • When will you check that the germ is gone?
  • Should my parents, children or partner be tested?

Frequently asked questions

Do I have H. pylori if I have no pain?

You can. Most people who carry the germ feel nothing. A breath or stool test is the way to find out.

How do I catch H. pylori in the first place?

Mostly in childhood, through close contact with family and shared food or water. It is not a sign of poor hygiene by one person.

Should my family be tested too?

Often yes, if you have an ulcer or a relative has had stomach cancer. Your doctor will say who in the home should be tested.

Can acid tablets hide the germ from a test?

Yes. Acid tablets and antibiotics can make a breath or stool test read negative. Tell your doctor, who may ask you to pause them for about two weeks.

Will clearing the germ stop my ulcer coming back?

In most people, yes, if the course works. A test at least four weeks later confirms it. Painkillers can still cause a new ulcer.

Is H. pylori linked to stomach cancer?

Long-standing infection can thin the stomach lining over many years, which raises the risk. This is why doctors prefer to clear the germ early.

Where Dr Harsh Shah sees patients and operates

Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad

Consultation, review of endoscopy, biopsy and scan reports, second opinions and follow-up.

+91-63555-64601 · Directions to the Gota clinic

Apollo Hospital, Bhat, Gandhinagar

Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Endoscopy and biopsy, CT scans, surgery for stomach and duodenal disorders, and inpatient care.

WhatsApp +91-63555-64601 · Directions to Apollo, Bhat

If you have been told you carry H. pylori, or you have a stomach ulcer, the germ is the first thing to sort out. For a second opinion on your test or scope report, send it ahead on WhatsApp. What suits you is decided after examination. Call +91-63555-64601 Send your reports before the visit

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Dr. Harsh J Shah
Dr Harsh Shah - Surgical Gastroenterologist and GI Robotic Surgeon, Ahmedabad
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