Helicobacter pylori (H. pylori) is a spiral-shaped bacterium that lives in the stomach and has been infecting people for a long time, with some times deadly results.
Find out what causes an infection, what the symptoms are, and how it is treated.
A little history
H. pylori was only recognised as an important cause of human disease in the mid-1980s when a young Australian surgeon, called Barry Marshall, identified it in the mucus layer lining the stomach. He became convinced that it was a major factor in stomach inflammation and peptic ulcer disease.
Marshall began working with Robin Warren, a pathologist at Royal Perth Hospital. Two years earlier, Warren had discovered the gut could be overrun by hardy, corkscrew-shaped bacteria called Helicobacter pylori.
Biopsying ulcer patients and culturing the organisms in the lab, Marshall traced not just ulcers but also stomach cancer to this gut infection. The cure, he realised, was readily available – antibiotics. But mainstream gastroenterologists were dismissive, holding on to the old idea that ulcers were caused by stress.
Unable to make his case in studies with lab mice (because H. pylori only affects primates), and prohibited from experimenting on people, Marshall finally ran an experiment on the only human patient he could ethically recruit – himself. He took some H. pylori from the gut of an ailing patient, stirred it into a broth, and drank it.
As the days passed, he developed gastritis, the precursor to an ulcer. He started vomiting, his breath began to stink, and he felt sick and exhausted. Back in the lab, he biopsied his own gut, culturing H. pylori and proving unequivocally that bacteria were the underlying causes of ulcers.
Why do we need to be concerned about H. pylori?
About 40 per cent of people in the UK have the Helicobacter pylori strain of bacteria in their stomach so it’s very common, and in the majority of people who have it, it doesn’t cause any problems. However, about 15 per cent of people with the condition get ulcers either in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer).
H. pylori bacteria typically make their home in the mucosal layer of the stomach, which protects the tissues lining your stomach and small intestine. When the inner layer of the stomach becomes inflamed, an ulcer can form. H. pylori is said to cause more than 90 per cent of duodenal ulcers and up to 80 per cent of gastric (stomach) ulcers.
H. pylori is also the only type of bacteria classified as a carcinogen because, if left untreated, it can progress to stomach cancer. Other complications include Barrett’s Oesophagus, a precursor to oesophageal cancer.
How does H. pylori infection occur?
H. pylori bacteria can be passed from person to person through direct contact with saliva, vomit or faecal matter. H. pylori may also be spread through contaminated food and/or water.
H. pylori bacteria are unique because they produce the enzyme urease that allows the bacteria to live in the harsh environment of the stomach. (Clever little bugs aren’t they being able to change an environment to suit themselves?). The urease enzyme they produce reacts with urea to form ammonia that neutralises enough of the stomach’s acid to allow the organisms to survive in the tissues. To learn more about the importance of stomach acid, read our ‘Stomach Acid. Why it’s so important to your health’ blog here.
Even though the stomach acid is lowered by these bacteria, people still get heartburn. This is because the stomach doesn’t get properly acidic, so it doesn’t empty its contents into the small intestine. Food sits in the stomach and ferments, and the by-product of fermentation is lactic acid (this is the ‘burn’ people feel when working out). It is thought that this lactic acid could be the source of heartburn in some individuals.
While proton pump inhibitors (PPIs) may make some people feel better, the risk usually outweighs the reward. If the stomach never reaches its proper pH, then a whole host of problems start to arise. For instance, minerals like calcium, magnesium, iron, zinc, copper, selenium, and boron are not absorbed well, if at all. Also, folate and B12 are poorly absorbed. Magnesium boasts over 300 functions in the body, one of them involves smooth muscle contraction which controls the valves in the GI tract. If the lower oesophageal sphincter (LES) is not contracting properly to keep it closed, this could allow for the contents of the stomach to come back up into the oesophagus, giving the feeling of reflux.
Since the stomach is designed to sterilise the contents of food, having low stomach acid due to H. pylori can set the stage for other bacteria to colonise the GI tract, triggering SIBO (small intestinal bacterial overgrowth), not to mention allowing viruses and parasites to enter the body via the oral route too.
Causes of H. pylori
- Family history of stomach cancer can increase your risk
- Low stomach acid (hypochlorhydria), which can be caused by acid-suppressing medication for gastro-oesophageal reflux disease (GORD) or lack of co-factors needed to produce stomach acid
- Regular, long-term antacid use
- Lifestyle factors (such as smoking, excess consumption of alcohol and coffee, diets high in sugar and trans fats, and stress can increase your risk for the development of an ulcer from H. pylori)
- Low nutrient status (low levels of Vitamin C and E can promote growth of H. pylori)
- Lowered immune system
- Antibiotic usage
Symptoms of H. pylori
- Bloating
- Frequent burping
- Nausea/vomiting
- Abdominal pain/a gnawing pain in the stomach (worse when the stomach is empty)
- Diarrhoea
- Heartburn
- Bad breath
- Anaemia
- Lowered appetite
- Ulcers
How to test for H. pylori
There are four ways to test for H. pylori infection:
- A stomach biopsy during endoscopy is one option, but is quite invasive. Results may vary depending on the sampling method, how widespread the infection is, and how the sample is tested after collection. For this reason, other testing methods may yield better results, and will certainly be less expensive and invasive.
- The Urea Breath Test (UBT) looks for the urease-virulence factor in your breath after ingesting a challenge solution
- An H. pylori blood test looks for antibodies to H. pylori. A positive result indicates present or past infection. This test is the least reliable for diagnosing H. pylori.
- Stool testing screens for H. pylori – some labs use PCR-DNA tests to screen for H. pylori DNA in your stool sample. The test also looks for how virulent the H. pylori strains you have are, which can provide some clues as to how damaging the infection is.
How is H. pylori usually treated?
The standard, first-line antibiotic treatment of Helicobacter pylori infection, called ‘triple therapy’, is 14 days of:
- A proton pump inhibitor (PPI) such as omeprazole, for its inhibitory effect on stomach acid, to allow healing of the stomach lining
- Two antibiotics together, such as amoxicillin, metronidazole, or clarithromycin
Even though this treatment is effective to start with, it can lead to other problems further down the line. Frequent antibiotic usage also eliminates beneficial bacteria in the gut. Any time the balance of intestinal organisms is disrupted, harmful organisms have an advantage, which can lead to an increased risk of IBS, IBD and systemic consequences. This can be avoided by using Live Bacteria probiotics during and after the use of antibiotics.
It’s important to be re-tested after the triple therapy to ensure it’s worked and has eradicated the H. pylori bacteria. Talk to your GP about being re-tested, especially if you still have the same or similar symptoms.
Natural approaches for the treatment of H. pylori
- Lifestyle changes, including stress management
- Dietary changes to help starve the bacteria, such as avoidance of sugar
- Probiotics have shown positive results in studies of the treatment of H. pylori
- Take a good quality multi-vitamin/multi-mineral supplement that contains Vitamins C and E
- De-glycyrrhizinated Licorice (DGL)
- Mastic gum – protects the lining of the stomach from ulceration and inhibits the growth of H. pylori
- Cabbage juice – studies have been undertaken to investigate its ability to help heal ulcers
- Bone broth (collagen) to heal the mucosal membranes in the gut
There are many other targeted supplements, including broccoli extract, that can be used to deal with this bacterial infection, but it is advised that you work with a qualified natural health therapist who is familiar with the supplement healing protocols, to guide you through this. This is because the protocol will depend on your unique make up, and whether you’re on any medications or have any other ongoing health conditions. For example, supplements will need to be checked for drug-nutrient interactions.
For example, De-glycyrrhizinated Licorice (DGL) is great for strengthening the protective mucus layer of the stomach, and healing ulcers, but is contraindicated with many drugs, and must not be used in people with high blood pressure or heart issues.
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