Helicobacter heilmannii: An Emerging Zoonotic Pathogen and the Hidden Cause of Feline and Canine Gastritis

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1.Introduction

The Helicobacter genus comprises a wide range of bacteria that have adapted to survive in the extreme and acidic environment of the stomach. Though H. pylori is the primary focus of human gastroenterology, NHPH, including H. heilmannii, are increasingly recognized for their clinical relevance [1, 2].In domestic pets, H. heilmannii is notably prevalent in both symptomatic and clinically healthy animals. The zoonotic potential of H. heilmannii, or the ability to transmit the bacteria from pets to their owners, adds a multifaceted public health issue to the management of this microorganism. Though it is associated with chronic gastritis and even gastric cancer in humans, H. heilmannii is still an understudied microorganism in relation to the human-animal bond [1, 3].


2. Prevalence and Pathogenesis in Pets

It is a common inhabitant of the stomach of dogs and cats. Studies for its prevalence have yielded a range of 41 to 100 percent in healthy dogs and cats, and similarly high percentages in dogs and cats suffering from gastrointestinal disorders. The infection in pets is associated with:

•Chronic Gastritis:

 A chronic inflammation of the stomach lining, resulting in vomiting and abdominal discomfort.

•Urease Production:

 Like H. pylori, H. heilmannii produces the enzyme "urease." This enzyme has the ability to counteract the stomach acid, thus helping the bacteria to thrive in the mucus lining of the stomach.

•Lymphofollicular Hyperplasia:

This is a specific immune response in the stomach wall, which is common in H. heilmannii infections. Though most of these animals are asymptomatic, the high load of H. heilmannii in their stomachs acts as a reservoir for potential infection.

3. Zoonotic Transmission and Human Health Impact

Though it is not common for humans to be infected by H. heilmannii compared to H. pylori, when it does happen, it is almost always a result of direct contact with domestic animals [1, 6]. The mode of transmission from animals to humans is through the fec-oral route, as well as the oral-oral route, during intimate contact like when a pet licks its owner’s face [3, 7].In humans, infection by H. heilmannii can result in the following diseases:

•Chronic Gastritis and Dyspepsia:

This includes symptoms like bloating, nausea, and abdominal pain [6, 8].

•Gastric MALT Lymphoma: 

This is a cancer of the immune tissue of the stomach. Interestingly, H. heilmannii is more commonly associated with this cancer than H. pylori [1, 8].

•Peptic Ulcers:

Though not as common as peptic ulcers caused by H. pylori, they can still be a result of infection by this organism [6].

4. Diagnostic and Treatment Challenges

It is difficult to diagnose H. heilmannii infection since it is a fastidious organism and is localized in the stomach of infected individuals.

•Diagnostic Tools: 

The only sure way of diagnosing this infection is through a biopsy of the infected individual’s stomach by endoscopy, followed by histopathology and rapid urease test [4, 9]. Breath tests, commonly used for H. pylori, are not reliable for H. heilmannii.

•Veterinary Treatment: 

The ideal treatment for infected dogs and cats is not well understood. The commonly used “triple therapy” for infected pets includes a combination of two antibiotics, such as Amoxicillin and Metronidazole, and an acid reducer like Omeprazole [5, 9].

•Recurrence: 

The high rates of recurrence of this infection, as well as the high failure rates of this treatment, are a result of the ubiquitous nature of this organism in the environment of infected pets [2, 5].

5. Research Gaps and Future Directions

There are significant research gaps that need to be addressed to effectively manage H. heilmannii. These research gaps are as follows:

•Transmission Pathways: 

The exact rate at which the bacteria jump from pets to humans is not clearly understood [3, 7].

•Individualized Therapy:

More research is necessary to establish effective antimicrobial susceptibility testing to ensure effective treatment for pets [9, 10].

•Public Awareness: 

There is an urgent need to raise public awareness, especially for pet owners with pre-existing gastric diseases, about the risks associated with close interactions with pet saliva [7].

•Long-term Human Outcomes: 

More research is necessary to establish the long-term risks of gastric cancer for people infected with Helicobacter species from animals.

6. Conclusion

Helicobacter heilmannii is an emerging pathogen that acts as a "bridge" between veterinary medicine and human medicine. This is due to its high prevalence in pets, which can cause serious gastric diseases for humans. This pathogen is an emerging zoonotic pathogen that requires effective management to ensure the safety of both pets and their owners. This can only be achieved by improving diagnostic techniques, treatment options, and raising public awareness about the risks associated with close interactions with pet saliva.

References

[1] Priestnall, S. L., et al. (2004). Evaluation of “Helicobacter heilmannii” Subtypes in the Gastric Mucosa of Cats and Dogs. Journal of Clinical Microbiology, 42(4), 114-120. https://pmc.ncbi.nlm.nih.gov/articles/PMC404595/
[2] VIN. (2006). Helicobacter in Dogs and Cats--What's New? https://www.vin.com/apputil/content/defaultadv1.aspx?id=3859031&pid=11223
[3] Bunea, A. M., et al. (2025). Beyond Helicobacter pylori: a critical review of Helicobacter heilmannii, an emerging zoonotic gastric pathogen. Romanian Journal of Laboratory Medicine. https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=30451655&AN=188890892
[4] Husnik, R., et al. (2022). Helicobacter Species and Their Association with Gastric Pathology in Dogs. Animals, 12(11), 1435. https://pmc.ncbi.nlm.nih.gov/articles/PMC9137851/
[5] Merck Veterinary Manual. Helicobacter Infection in Small Animals. https://www.merckvetmanual.com/digestive-system/diseases-of-the-stomach-in-small-animals/helicobacter-infection-in-small-animals
[6] Geng, C., et al. (2021). Helicobacter heilmannii Infection: Dog-Derived Dyspepsia? The American Journal of Medicine, 134(9), e501-e502. https://www.amjmed.com/article/S0002-9343(21)00325-9/fulltext
[7] Moussa, I. M., et al. (2021). Zoonotic risk and public health hazards of companion animals in the transmission of Helicobacter species. Journal of King Saud University - Science, 33(5), 101455. https://jksus.org/zoonotic-risk-and-public-health-hazards-of-companion-animals-in-the-transmission-of-helicobacter-species/
[8] Gastroenterology Advisor. (2022). H heilmannii Infection Linked to Chronic Gastritis Among Patients with Dyspepsia. https://www.gastroenterologyadvisor.com/news/h-heilmannii-infection-linked-to-chronic-gastritis-among-patients-with-dyspepsia/
[9] AskAVet. (2025). Vet's 2025 Guide to Canine Gastric Helicobacter spp. Infection. https://askavet.com/blogs/news/vet-s-2025-guide-to-canine-gastric-helicobacter-spp-infection-%F0%9F%90%B6%E2%9C%A8
[10] Dumra, S., et al. (2025). Recent advances in Helicobacter pylori diagnosis, treatment, and management. Exploration of Digestive Diseases. https://www.explorationpub.com/Journals/edd/Article/100598

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