Helicobacter Pylori
What you need to know about H.Pylori
Chances are if you have heard of this little critter, it’s because either you or someone you know have tested positive for H.Pylori after seeing your GP for gastritis-type symptoms or stomach ulcer (Gastritis is inflammation of the stomach lining).
Here we will discuss what it is, how it is contracted, the effects and the common symptoms and what can be done to treat it.
What is Helicobacter Pylori?
Helicobacter pylori (H. Pylori) is a gram-negative spiral-shaped bacteria that can burrow into the mucosal layer of the stomach and small intestine. A gram-negative bacterium means that it has a thin cell wall that can make it resistant to many antibiotics.
Although it is thought to have been infecting humans for thousands of years, it was only discovered by two Australian researchers in 1982, who went on to win the Nobel Prize for their discovery in 2005.
How do you contract it?
H. Pylori is thought to be transmitted from saliva, vomit or faecal matter but the exact route is still unclear. The most common ways to catch H. Pylori are likely:
Contact with saliva
Contact with faecal matter
Contaminated food or water
Poor hygiene - e.g. lack of hand washing.
Given the increased prevalence in certain regions, travelling to developing countries may increase your risk of H. pylori infection.
One of our body’s major defence mechanisms, stomach acid, is designed to prevent infections like H. pylori. We talk a lot about stomach acid in this blog, however, because H.Pylori likes to reside in the stomach, those with low levels of stomach acid may be at higher risk.
The main reasons someone may have low stomach acid are:
H.pylori itself is able to neutralise stomach acid to make it a more hospitable place to live (explained further on).
Age - as our gastric acid secretions reduce as we get older.
Stress (physical and emotional), which can impact the production of stomach acid.
Deficiencies in vitamins or minerals essential to stomach acid production (e.g. zinc and vitamin B6), may lead to low stomach acid.
Proton pump inhibitors and antacids, which are specifically designed to reduce the volume and acidity of stomach acid.
GI surgery (e.g. gastric bypass surgery) can reduce the amount of stomach acid produced.
How H.Pylori makes the stomach a cosy home
Nobody thought bacteria could survive in the highly acidic environment of the stomach, but it is now known that H. pylori can hang out there and cause up to 80% of gastric and other GI ulcers, chronic gastritis and stomach cancer, and other upper GI symptoms and conditions. It manages to survive this harsh environment through two different mechanisms.
H. pylori’s ability to produce an enzyme called urease which is hydrolysed into ammonia and neutralises stomach acid. It is this reduction in stomach acidity that allows H. pylori to continue living in what would otherwise be too harsh an environment.
Burrowing into the less acidic mucosal layer that lines the stomach that protects it from its acidic habitat.
Additionally, as stomach acid is an important first line of defence for our immune system to kill off ingested pathogens, the risk of further infections also increases as the acidic environment is made more alkaline. If you have H. pylori, you tend to find other pathogens or overgrowths in the GI tract for this reason.
What are the Symptoms of infection?
H.pylori produce enzymes and toxins that interfere with the protective lining of gastric mucosa, producing intense inflammation and triggering an immune response.
Some people with H.pylori infection develop clinical disease and symptoms, and others do not. Symptoms include:
An ache or burning pain in your stomach.
Heartburn or reflux, leading to GERD - see below
Stomach pain that may be worse when your stomach is empty.
Nausea.
Loss of appetite.
Frequent burping.
Bloating.
Unintentional weight loss.
Bad breath (Halitosis) particularly after eating protein.
Fatigue
Gastritis
Migraines
Dark or tarry stools
Diarrhoea
Anaemia (low red blood cell count)
Chronic malabsorption (from lack of acidity in the stomach)
Duodenal/Peptic ulcers
Acne
Headaches
Undigested food in the stool
Carcinoma
Common symptoms of H.Pylori infection
Peptic ulcer - is an ulceration of the mucous membrane in the stomach or duodenum (very first part of the small intestine where the stomach empties its contents). Traditionally, stomach ulcers were thought to be caused by stress and seen as a chronic incurable disease.
It has been discovered that H.pylori and non-steroidal anti-inflammatory drugs (NSAIDS) were mainly to blame (NSAIDS are medications like aspirin and ibuprofen). The most common symptom of peptic ulcers is pain described as gnawing or burning.
Acid Reflux and GERD - What’s the connection with H.Pylori?
Low stomach acid is one of the causes of acid reflux and GERD. The sphincter that closes off the stomach from the oesophagus after food has entered needs a certain level of acidity to seal it up properly. When stomach acid has been neutralised (lowered), the sphincter can remain open or at least not completely shut. When this happens the gastric juices can flow back up the oesophagus and result in acid reflux and GERD.
Because H. pylori neutralises it is a common root cause of acid reflux and GERD in many clients.
Diagnosing/testing:
There are a number of H. pylori testing options are available for identifying the presence of an infection.
Breath test - a Urea breath test shows if you are infected by analysing a sample of your breath. While breath tests are typically accurate, safe, simple and quick to perform, they aren’t able to determine the presence of virulence factors. They are, however, a particularly useful test to check whether the infection has been successfully treated.
Stool test - advanced DNA (PCR) stool testing identifies the presence of H. pylori and virulence factors known to worsen symptoms. A stool test can also identify other co-infections that may be contributing to GI symptoms.
Blood tests - These can identify a history of infection. They are not useful for checking whether the infection is current or has been successfully treated because the antibody to H. pylori (the marker of the body’s response to infection) can remain in the blood for years.
Endoscopy - The infection may be found at the same time as a peptic ulcer, with an invasive test called an endoscopy. This procedure involves inserting a small camera into the digestive tract to look for signs of infection. H. pylori can be detected by a number of methods - including looking at samples under a microscope, using a chemical reaction or growing it in the laboratory.
Treatment Options
There are several treatment options available for H.pylori, including both antibiotics and natural treatments. I recommend working with a practitioner to address H.pylori if you are symptomatic and have this bacteria in your GI tract.
Eradication or treatment can be difficult. Pharmaceutical treatment uses a treatment called “Triple Therapy'', which is a combination of three medications (2 antibiotics and Omeprazole). If this fails, quadruple therapy is utilised under the guidance of a gastroenterologist.
Triple and quadruple therapy can cause long term damage to our gut microbiome.
Antibiotics used to be the first-line therapy for H. pylori. However, due to increasing antibiotic resistance to key antibiotics, efficacy rates have dropped to rates lower than 70% and are no longer considered gold-standard, even in conventional medicine. In addition, there can be long-term damage to our gut microbiome associated with broad-spectrum antibiotics. See my blog on antibiotics to learn more.
Natural treatment approaches have become increasingly well researched, effective and preferred in clinical practice in recent years. For a gentler, but affective approach look at diet, lifestyle and specific supplementation.
Diet
Diet alone will not eradicate H. pylori, but we can certainly help support our bodies by introducing and removing certain foods to reduce inflammation and reliance on stomach acid during the eradication phase. The following may help reduce inflammation:
Removing inflammatory foods like processed foods, alcohol, gluten, dairy and sugar.
Eating cooked rather than raw food.
Smaller meal sizes.
Avoid caffeine and carbonated drinks, spicy and pickled foods.
The following foods have been studied for their anti-H. pylori effects, with many clinicians including them in protocols to aid eradication. Honey, Green tea, Fish oil (omega-3 source) from supplements or oily fish like sardines, mackerel, salmon or herring, Broccoli sprouts, Turmeric.
LIFESTYLE RECOMMENDATIONS
Stress reduces our production of stomach acid. Incorporating routines that help us reduce stress, especially around meal times can be supportive.
Relaxing forms of movement like walking and yoga.
Take a few moments before meals to slow down, breathe and just generally be more mentally present while eating. This switches your body from “fight or flight” to “rest and digest”. Take 3-4 big deep breaths before eating.
Aim for at least 8 hours of sleep per night to ensure you’re giving the body enough space to rest and repair.
Products and supplements I like to use include:
Supplements to block urease production by H.Pylori like sulforaphane.
Biofilm disruptors. Some examples include Curcumin, N-Acetyle Cysteine, and Pomegranate.
Natural antimicrobials to eradicate H.Pylori.
A healing gut powder to soothe the gut lining containing nutrients like glutamine, zinc, Vitamin D, and Vitamin A.
Hydration, foods and supplements that support detoxification of toxins and “die off” effect.
Nutrients to help restore digestive function, and production of stomach acid (zinc, B6).
H. pylori is a common bacterial infection that can cause a range of symptoms, including abdominal pain, nausea, and loss of appetite. It is spread through contaminated food and water, as well as through contact with infected individuals. If you suspect that you may have an H. pylori infection, it is important to seek professional support for testing and treatment. With the right treatment, tailored individually for you, most cases of H. pylori can be successfully cured.
https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171
https://www.racgp.org.au/afp/2014/may/helicobacter-pylori-eradication