In recent years, Helicobacter pylori (H. pylori) has been identified by researchers as the cause of the majority of gastrointestinal ulcers. H. pylori is a bacterium that lives in the stomach and duodenum. It has a unique way of adapting to the usually harsh environment of the stomach.
Gastric juice is composed of digestive enzymes and concentrated hydrochloric acid, which can readily digest food or kill microorganisms. Low levels of stomach acid increase the chance an organism’s survival. It used to be thought that the stomach contained no bacteria and was actually sterile.
The stomach is protected from its own gastric juice by a thick layer of mucus that covers the stomach lining. H. pylori takes advantage of this protection by living in the mucus lining.
Once H. pylori is safe in the mucus, it is able to fight the stomach acid that does reach it with an enzyme it possesses called urease. Urease converts urea, of which there is an abundant supply in the stomach (from saliva and gastric juices), into bicarbonate and ammonia, which are strong bases. This creates a cloud of acid-neutralizing chemicals around the H. pylori, protecting it from the acid in the stomach. The breath test method of diagnosis relies on this reaction being present.
Contributing to the protection of H. pylori is the fact that the body’s natural defenses cannot reach the bacterium in the mucus lining of the stomach. The immune system will respond to an H. pylori infection by sending white cells, killer T cells, and other infection fighting agents. However, these potential H. pylori eradicators cannot reach the infection, because they cannot easily get through the stomach lining. They do not, however, go away – the immune response just grows and grows. White cells die and spill their destructive compounds (superoxide radicals) on stomach lining cells. Extra nutrients are sent to reinforce the white cells, and the H. pylori can feed on this. Within a few days, gastritis and perhaps eventually a peptic ulcer results. It may not be H. pylori itself which causes peptic ulcer, but the body’s response (inflammation of the stomach lining).
H. pylori is believed to be transmitted orally. Many researchers believe that H, pylori is transmitted orally by means of fecal matter through the ingestion of waste-tainted food or water. In addition, it is possible that H. pylori could be transmitted from the stomach to the mouth through gastro-esophageal reflux or belching, common symptoms of gastritis. The bacterium could then be transmitted through oral contact.
A 2002 trial demonstrated that a mixed probiotic acidophilus preparation failed to eradicate the H. pylori infection in the patients upon whom it was tried.
Conditions that suggest Helicobacter Pylori Infection
Crohn's Disease
Drug therapies used to fight the ulcer-causing bacteria Helicobacter Pylori may help treat Crohn’s disease. Researchers recently reported that “after treatment [with antibiotics against H. Pylori], clinical remission [of Crohn’s disease] was achieved in all patients”, regardless of the type of therapy received. At the same time, H. Pylori infection was eradicated in 28 of the 30 infected patients.
“What this shows is that by eradicating H. Pylori infection… we achieved a remission of Crohn’s disease,” Dr. Mantzaris explained. The authors stress that their findings do not mean that H. Pylori causes Crohn’s disease. But it does raise the issue of “whether regimens aimed at eradicating H. Pylori in infected patients with Crohn’s disease may also achieve remission of Crohn’s disease.”
Gastritis
Helicobacter Pylori is believed to be the cause of superficial gastritis.
Rosacea
A high incidence of Helicobacter pylori infection in the stomach has been found amongst rosacea patients.
H. Pylori infection
Cancerous/benign stomach polyps
Fundic gland polyps of the stomach are rarely associated with the presence of Helicobacter pylori in the stomach. In this study for example, H. pylori was found in 0.1% of patients with fundic gland polyps but was present in 13% of patients without fundic gland polyps. [Oral presentation at the American College of Gastroenterology meeting, Oct 2008]
However, Helicobacter pylori is responsible for lesions in the stomach lining. And, such ulcers become a cause for hyperplastic polyps.
Stomach Polyps
The most common cause of stomach polyps is chronic gastritis. Persistent irritation of the stomach lining triggers excessive growth of normal cells (hyperplasia). If the gastritis is a result of long term H.pylori infection, successful eradication and appropriate treatment of H.pylori gastritis may lead to the polyp resolving spontaneously.
Risk factors for Helicobacter Pylori Infection
Hydrochloric Acid Deficiency
Infection with H. (helicobacter) pylori can impair HCL production. Low HCL production may also contribute to an overgrowth of H. pylori.
Dysbiosis, Bacterial
The speculation on validity of restoration of the gastric microecosystem has been demonstrated by therapeutic effects of Lactobacilli Bulgaricus (LBG) administration on H. pylori-associated diseases (invitro). But whether Lactobacilli inhibit H. pylori-LPS-induced IL-8 production through blocking H. pylori-LPS-activated TLR4 pathway hasn’t been well researched. A research article published on August 28, 2008 in the World Journal of Gastroenterology addresses this question.
This evaluation of LBG as a probiotic model revealed an important and novel relationship between H. pylori-LPS-activated TLR4 signaling and selective microflora. This report adds to our understanding of the signal pathways in the gastric epithelia involved in inflammatory responses that are regulated by probiotics and pathogenic bacteria composing the gastric microecosystem.
Probably/history of H. Pylori infection
History of gastritis
Helicobacter Pylori is believed to be the cause of superficial gastritis.
History of stomach ulcer
Counter Indicators
History of H. Pylori infection
Helicobacter Pylori Infection suggests the following may be present
Crohn's Disease
Drug therapies used to fight the ulcer-causing bacteria Helicobacter Pylori may help treat Crohn’s disease. Researchers recently reported that “after treatment [with antibiotics against H. Pylori], clinical remission [of Crohn’s disease] was achieved in all patients”, regardless of the type of therapy received. At the same time, H. Pylori infection was eradicated in 28 of the 30 infected patients.
“What this shows is that by eradicating H. Pylori infection… we achieved a remission of Crohn’s disease,” Dr. Mantzaris explained. The authors stress that their findings do not mean that H. Pylori causes Crohn’s disease. But it does raise the issue of “whether regimens aimed at eradicating H. Pylori in infected patients with Crohn’s disease may also achieve remission of Crohn’s disease.”
Helicobacter Pylori Infection can lead to
Increased Risk of Stomach Cancer
Helicobacter Pylori infection leads to a significantly increased risk of stomach cancer.
Rosacea
A high incidence of Helicobacter pylori infection in the stomach has been found amongst rosacea patients.
Recommendations for Helicobacter Pylori Infection
Probiotics / Fermented Foods
Supplementation for one month with Lactobacillus and Bifidobacterium yogurt after one week of triple antibiotic therapy enhanced H. Pylori eradication. Only those patients supplemented with yogurt showed restoration of Bifidobacterium in their stools compared to the levels at the beginning of the trial. [Aliment Pharmacol Ther 2002;16(9): pp.1669-1676]
Using Lactobacillus johnsonii from a fermented milk product for 4 months reduced gastric inflammation and H. pylori density and improved mucus thickness in a well-controlled study of 50 patients with gastritis and H. pylori. [Aliment Pharmacol Ther 2003;18(8): pp.805-14]
A review of thirteen human studies concluded that probiotics may have a place as prophylaxis and supportive treatment of Helicobacter pylori infections. [Int J Antimicrob Agents 2003;22(4): pp.360-6]
Propolis / Bee Products
In a clinical trial of 45 patients with dyspepsia, the subjects were given 30ml (about 1 ounce) of raw honey three times a day. After treatment, the number of patients with blood in their stools caused by peptic ulcers decreased from 37 to 4; the number of patients with dyspepsia decreased from 41 to 8; the number with gastritis or duodenitis, as viewed by endoscope, decreased from 24 to 15; and the number with duodenal ulcers decreased from 7 to 2. In another study on gastric ulcers, the healing rate from raw honey was 70%, measured as the number of honey-treated ulcers compared to the untreated control group. A study in 1994 showed that the Manuka antibacterial factor in raw active Manuka honey completely halted the growth of Helicobacter pylori (the bacteria responsible for upper G.I. dyspepsia of stomach ulcers) at concentrations as low as 5%, but the hydrogen peroxide components in other honeys did not, even at concentrations as high as 50%.
Mastic Gum
Mastic Gum kills H. Pylori. [NEJM 1998 Dec 24;339(26):1946]
However, a 14 day trial with mastic gum (1 gm QID) had no effect on Helicobacter pylori status in a study of nine patients with H. pylori infection and no ulcers. [ J Antimicrob Chemother 2003;52(3): pp.522-3]
Tea Tree oils (Melaleuca / Leptospermum - Manuka)
Tea tree oil, taken internally, is reported to be useful in killing H. Pylori when taken at 15 drops of 100% strength twice daily. It may need to be taken in juice in order to mask it’s strong flavor and with a pinched nose to mask it’s odor.
Increased Water Consumption
Drinking more water alone has resolved many cases of H. Pylori infection. The suggested amount is 1 quart per 50 pounds of body weight or generally about 12 glasses per day. Most ulcers can be treated with water consumption and regular use of a good probiotic product. (Am J Gastroenterol May 1999;94: pp.1200-1202.)
Antibiotics
It is not recommended to treat H Pylori with a single medication so combination therapy should always be used. There are a number of combination therapies in common use e.g. dual, triple and quadruple, but at this time the most proven effective treatment is a 2-week course of triple therapy. This involves taking two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shield. This therapy regimen reduces ulcer symptoms, kills the bacteria and prevents recurrence in more than 90% of patients.
At this time, in Austrailia, a proven and effective treatment for H. pylori is a 7-day course of medication called Triple Therapy comprising two antibiotics, amoxicillin and clarithromycin, to kill the bacteria together with an acid suppressor to enhance the antibiotic activity. This regimen of triple therapy reduces ulcer symptoms, kills H. pylori and prevents ulcer recurrence in more than 80% of patients. Antibiotic regimens recommended for patients may soon differ across regions of the world because different areas have begun to show resistance to particular antibiotics.
Essential Fatty Acids
Essential fatty acids have the ability to inhibit the growth of Helicobacter pylori and suppress acid production.
Vitamin C (Ascorbic Acid)
A study showed vitamin C levels to be low in atrophic gastritis and Helicobacter Pylori infection.
Vitamin B12 (Cobalamine)
H. Pylori infection may result in Vitamin B12 deficiency.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Helicobacter Pylori
H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.
Gastrointestinal
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Ulcer
Lesion on the skin or mucous membrane.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Duodenum
First portion of the small intestine between the pylorus and jejunum.
Enzymes
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Hydrochloric Acid
(HCl): An inorganic acidic compound, excreted by the stomach, that aids in digestion.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Immune System
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Gastritis
Inflammation of the stomach lining. White blood cells move into the wall of the stomach as a response to some type of injury; this does not mean that there is an ulcer or cancer - it is simply inflammation, either acute or chronic. Symptoms depend on how acute it is and how long it has been present. In the acute phase, there may be pain in the upper abdomen, nausea and vomiting. In the chronic phase, the pain may be dull and there may be loss of appetite with a feeling of fullness after only a few bites of food. Very often, there are no symptoms at all. If the pain is severe, there may be an ulcer as well as gastritis.
Peptic Ulcer
A general term for gastric ulcers (stomach) and duodenal ulcers (duodenum), open sores in the stomach or duodenum caused by digestive juices and stomach acid. Most ulcers are no larger than a pencil eraser, but they can cause tremendous discomfort and pain. They occur most frequently in the 60 to 70 age group, and slightly more often in men than in women. Doctors now know that there are two major causes of ulcers: most often patients are infected with the bacteria Helicobacter pylori (H. pylori); others are regular users of non-steroidal anti-inflammatory drugs (NSAIDS), which include common products like aspirin and ibuprofen.
Probiotic
Derived from the Greek word for "life." Probiotic refers to organisms and substances which contribute to intestinal microbial balance. They are beneficial or "friendly" intestinal bacteria.
Acidophilus
A microflora (good bacteria) that acts as a digestive aid and lives in your intestines helping your body fight disease.
Crohn's Disease
Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Polyp
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.