Most people think that a stomach ulcer is a result of stress or spicy food. Millions of people suffer from stomach ulcers every day, and most of them are triggered by stomach bacteria.
Helicobacter pylori (H. pylori) is a bacterium that resides in the stomach lining. It is among the most prevalent bacterial infections seen in the world, with an estimated 44% of the world’s population being affected. In the United States, it is estimated that about 30-40% of the adult population is infected. H. pylori infection may result in a variety of complications, such as chronic gastritis and painful peptic ulcers. This bacterial overgrowth can also cause iron deficiency anemia, fatigue, and bloating.
What is H. Pylori and what does it do in your body?
Your stomach is a very acidic place, meant to digest food and eliminate pathogens. It is a delicate balance of hard hydrochloric acid and a thick mucous layer that coats the stomach.
This is how H. pylori interferes with this system:
It neutralizes your acid: To survive the stomach’s harsh environment, H. pylori produces an enzyme called urease. This enzyme creates a cloud of ammonia around the bacteria, neutralizing the stomach acid in its immediate vicinity so it can safely burrow into your stomach wall.
It eats away the lining of your stomach: The ammonia it creates is harmful to the stomach cells. This weakens the thick lining of the stomach tissue, which is supposed to protect it.
It causes chronic gastritis: When H. pylori is present, your immune system continually attacks the lining of your stomach. This chronic inflammation causes a decrease in stomach acid and digestive enzyme production.
In the presence of an H. pylori infection, all of these systems break down. This results in the thinning of the mucous lining, acid starts to burn the lining of your stomach, food remains undigested in your gut, and causes a lot of discomfort.
H. pylori infection is responsible for approximately 90% of duodenal ulcers and 70 to 80% of gastric ulcers. Once eradicated, ulcers will heal, and the risk of recurrence is greatly diminished (about 80% within 1 year without treatment, or less than 10% with successful eradication).
How Do You Get H. Pylori Infection?
Contrary to popular belief, you do not only get H. pylori from traveling to developing countries. This bacterium is transmitted much closer to home. It spreads through saliva and bodily fluids such as:
- Sharing utensils
- Using the same cup or glass
- Kissing someone who is infected
- Contact with an infected person’s fecal matter
- Contaminated water and food
It frequently occurs between members of the same family in the same home. In less developed countries, where clean water and sanitation are more difficult to find, infection rates can be as high as 70-90% of adults. In developed countries, such as the USA, these rates are still considerable but lower.
It takes advantage of low stomach acid. This is the least obvious cause. If you are chronically stressed, aging, or taking antacids and proton pump inhibitors (PPIs), your stomach acid drops. and may cause this infection.
Who Is at Highest Risk for H. Pylori Infection?
The following groups are more likely to develop and be affected by H. pylori:
Frequent antacid users. Regular consumption of Tums, Pepcid, and prescription PPIs is depriving the stomach of its acid, leaving it an ideal environment for the bacteria to enter and multiply.
Stress. When the body is experiencing a high level of cortisol, stomach acid production is suppressed, and the body’s immune system is unable to guard the digestive tract naturally.
Living with the infected partner or family member. It is spread via saliva, so if one person in a household has it, there is an extremely high likelihood that they all have it.
People who eat out frequently or use ice machines. The bacteria can often come from contaminated ice or improperly handled food in restaurants.
People who reside in or migrate from countries with high prevalence: These include countries in Latin America, Eastern Europe, Asia, Africa, and the Middle East, where infection rates are much higher than in the United States.
Overcrowded Homes: This is especially prevalent in houses where several members of the family share the same bathroom and have limited access to clean water.
Contaminated water sources: This occurs due to the consumption of untreated or unfiltered water in high bacterial water areas.
H. Pylori Symptoms
About 80% of people infected with H. pylori do not experience any symptoms, or symptoms are mild, but not specific enough to be linked to H. pylori infection. If symptoms do occur, they are related to the damage to the stomach lining and may differ if the infection has led to gastritis, an ulcer, or more advanced damage. Here are the signs you should watch for:
- A burning pain in the upper abdomen
- Nausea, particularly in the morning or before meals
- Bloating and excessive belching
- Loss of appetite
- Unintentional weight loss
- Burping and indigestion
- Dark or tarry stools
- Iron deficiency anemia without an obvious cause
If your infection has caused an actual ulcer, symptoms include vomiting (which may contain blood that appears like dark coffee grounds), black tarry stools, or sudden sharp abdominal pain. This is the time when medical intervention is essential.
H. pylori Standard Medical Treatment
H. pylori cannot be treated with a single antibiotic or a probiotic. Triple Therapy is the only therapy used mainly in standard medicine. It is a two-week treatment of two antibiotics and a proton pump inhibitor (PPI).
1. Triple or Quadruple Therapy
Triple therapy is the initial therapy for H. pylori. It is used for 14 days and includes the use of a proton pump inhibitor (PPI) in combination with two antibiotics, such as clarithromycin and amoxicillin (or metronidazole if a person is allergic to penicillin). The PPI helps to heal the mucosa and also makes the antibiotic environment more effective due to its ability to decrease stomach acid.
But, in many areas of the United States, clarithromycin drug resistance has risen sharply.
Bismuth quadruple therapy is recommended as the first-line choice in regions where clarithromycin resistance is more than 15%. This involves a PPI, along with bismuth subsalicylate, tetracycline, and metronidazole, and is usually administered for 10 to 14 days.
Eradication rates with bismuth quadruple therapy exceed 90% even in the presence of clarithromycin resistance.
2. If First-Line Treatment Fails
Treatment failures are not rare and occur at approximately 10-20% even when treatment is administered as per first-line guidelines. This happens due to antibiotic resistance. If the test of cure shows that the infection is not cured after the first round of treatment, then the course changes:
- A different combination of antibiotics is given
- Endoscopic biopsy can be performed to culture and sensitize the organism to help determine the appropriate antibiotics for salvage therapy.
- Levofloxacin-based triple therapy and bismuth quadruple therapy (if not used first-line) are the most common salvage regimens.
- Second-line therapy is usually given for 14 days.
If your symptoms improve, do not stop taking the antibiotic earlier. H. pylori is a very hard to treat bacteria and short course of antibiotic treatment is one of the most common causes of antibiotic resistance. Follow all of the protocol exactly as given.
The side effects may include nausea, altered taste, and diarrhea. These are common with these regimens and are often temporary.
Steps to Eradicate H. Pylori and Heal Your Gut
But don’t take an ulcer lightly if it invades your stomach. Here’s what you should do:
Get the Right Test: First, do not accept a standard blood test. A blood test only checks for antibodies, meaning it will be positive if you had H. pylori twenty years ago. Your provider will need to order a Stool Antigen Test or a Urea Breath Test. It is the most effective way of proving you have an active infection.
Use Targeted Natural Antimicrobials: Instead of immediately resorting to broad-spectrum antibiotics, utilize targeted natural compounds. The resin from the pistachio tree, called mastic gum. It has been clinically proven to eradicate H. pylori. Other very effective remedies are Bismuth subcitrate, Zinc Carnosine, and extracts such as Berberine. These destroy the bacteria without harming your good gut flora.
Soothe and Repair the Lining: In addition to eradicating the bacteria, you need to repair the damage it has caused. DGL (Deglycyrrhizinated Licorice) coats the stomach and increases mucosal protection. Take 2 tablets of DGL before meals. L-Glutamine powder is also required to rebuild the physical tissue of the stomach wall.
Rebuild Your Microbiome with the Right Probiotics: You cannot just take any probiotic. Saccharomyces boulardii is a beneficial yeast that specifically eats up H pylori and stops it from sticking to the lining of the stomach. Once you have overcome the infection, you will need to switch to a good-quality, diverse probiotic that will restore your whole digestive system.
Eradication should always be confirmed post-treatment. You need a test of cure (urea breath test or stool antigen test) at least 4 weeks after completion of antibiotics and 2 weeks after discontinuation of PPIs.
Bottom Line
H. pylori is not a condition that manages itself or goes away with dietary changes and antacids. It’s highly treatable in primary care when it is identified. The treatment is a 10 to 14-day course of antibiotics and is very effective if used properly and for the correct duration.
At Kairos Integrative Care, Lola, one of our integrative health practitioners, will look at your advanced stool testing, identify if H. pylori is the hidden culprit behind your symptoms, and create an easy-to-follow plan to eradicate the bacteria and rebuild your gut lining without destroying your microbiome.
We see patients in Houston, Sugar Land, Richmond, and nearby areas (77046 & 77478). We accept most major insurance plans, including Blue Cross, Aetna, Ambetter, Cigna, and more.
New patients are welcome, and if you can’t make it to the clinic, telemedicine visits are available for patients across the entire state of Texas.
Book your appointment today!
