Ultimate Guide to H. Pylori

This is your ultimate guide to H. pylori! What is it, the best way to test for it, conventional treatment vs natural remedies, and how to prevent recurrence. 

 
Note from Dena: This post was written by Brianna Rivera, Dietetic Intern, as part of a research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.  

Everything you need to know about H. pylori: What are the symptoms, how is it diagnosed, and what are the treatment options, including conventional medicine and natural remedies? This guide covers it all!

Helicobacter pylori (H. pylori) Infection – What is it?

Helicobacter pylori, also known as H. pylori, is a bacterial infection of the stomach. It is also occasionally found in the upper small intestine.

In 2015, 4.4 billion individuals globally were estimated to be infected with H. pylori. In the United States, H. Pylori infects 30% to 40% of the nation (1).

The severity of the infection differs from person-to-person. For some, it may not cause any health related risks; but, when H.pylori overgrows or produces virulence  factors (CagA, VacA, etc.), it increases the risk for more serious problems like stomach ulcers and cancer.

What are the Symptoms of H. pylori?

The most common signs and symptoms include:

• Heartburn/reflux/GERD
• Stomach/upper abdominal pain
• Bloating
• Stomach ulcers
• Burping
• Lack of appetite
• Nausea/vomiting
• Bad breath
• Some will have no symptoms at all

How Do You Get H. pylori?

H. pylori is spread through direct contact with infected saliva, vomit, or feces (2). Since it passes through saliva, it is very common for members of the same household to pass the infection to one another. 

Contaminated food and water can also transmit the infection. H. pylori is most common in developing countries where access to clean, safe food and water is limited.

Pets can pass H. pylori too! Dogs and cats can both carry and transmit the bacteria to their owners, especially if they’re allowed to lick faces.

Low stomach acid also increases the risk of H. pylori. Stomach acid is our first barrier against incoming bacteria, viruses, and parasites but, if stomach acid is already low due to chronic stress, zinc deficiency, or use of medications that suppress acid like proton pump inhibitors (PPI’s) or H2 blockers, these organisms are more likely to take up residence in our digestive tract. Unfortunately, H.pylori can further suppress stomach acid, setting you up for poor digestion and overgrowth of other bacteria, yeasts, and parasites.

Health Complications

For many people, H.pylori is the “first domino to fall,” leading to a cascade of downstream effects.

• LOW (OR HIGH) STOMACH ACID – H. pylori releases an enzyme called urease which weakens the stomach lining by making it less acidic. Low stomach acid can lead to vitamin and mineral deficiencies, and allows for ingested viruses and bacteria to survive transit through the stomach and colonize the lower intestine and colon (3). Some research has shown increased stomach acid levels in H.pylori patients – it’s not yet clear whether this difference relates to the severity of infection, how long it has been present, or other factors. 
• VITAMIN B12 DEFICIENCY – Vitamin B12 deficiency results from low stomach acid, or from more serious cases like stomach cancer where parietal cells are damaged. Parietal cells that line the stomach produce stomach acid and a protein called intrinsic factor which is needed for vitamin B12 absorption (4).
• OTHER VITAMIN & MINERAL DEFICIENCIES – H. pylori infections also cause zinc, copper, magnesium, folic acid, iron, vitamin A, C, and E deficiencies. Low stomach acid impairs the body’s ability to absorb these vitamins and minerals. Additionally, minerals and electrolytes are rapidly lost if H. pylori causes diarrhea (5,6).
• GASTROESOPHAGEAL REFLUX DISEASE (GERD) – Studies have shown various individuals experiencing heartburn, reflux, and other symptoms of GERD were also positive for H. pylori. The treatment of H. pylori will not always fix the symptoms associated with GERD. There are conflicting studies that show the eradication of H. pylori improved heart burn and acid reflux, while in others it increased these symptoms (7,8).
• INFLAMMATION – H. pylori stimulates inflammatory and immune responses in the stomach that can damage the stomach lining. Some virulence factors such as VacA and CagA, increase inflammation and risk for stomach ulcers and cancer. These two toxins are secreted into the stomach lining allowing the bacteria to invade and easily attach to the stomach wall. VacA and CagA are expressed in only a small number of H.pylori cases (9).
• ULCERS – Most people can live with H. pylori without getting ulcers. However, in some individuals – especially those where H.pylori produces certain virulence factors as mentioned above – damage can be done to the stomach lining. This provides an entrance for bacteria and acid to enter which leads to the formation of painful ulcers. Ulcers can cause infections, bleed, block food from moving through the GI tract, and even lead to cancer.
• STOMACH AND ESOPHAGEAL CANCER – Researchers speculate that the long-term inflammatory response to H. pylori – especially cases where certain virulence factors are present – causes the cells in stomach lining to become cancerous in about 2% of cases. On the other hand, the decline of stomach acid in the presence of H. pylori reduces acid reflux into the esophagus, lessening the risk of esophageal cancer (10).
• SIBO (SMALL INTESTINAL BACTERIAL OVERGROWTH) – Decreased stomach acid leads to poorly digested foods that move more slowly through the GI tract, providing a veritable buffet for bacteria and yeast to feast on. Bacteria taking over the small intestine can cause an interference with the absorption of vitamins and minerals from food. Read more about SIBO here!
• IBS? – Research to date has shown conflicting results regarding a relationship between H.pylori and IBS. (11, 12) However, clinically we often see classic IBS symptoms in individuals with H.pylori, and symptoms often improve or resolve when we address H.pylori.
• SKIN RASHES – H.pylori produces histamine, which can exacerbate eczema, hives, psoriasis, and other skin rashes. More research is needed, but some studies show that eradicating H.pylori may help resolve chronic skin issues. (13, 14)
• FATTY LIVER – A meta-analysis found that H.pylori positive individuals had approximately 25% higher rates of nonalcoholic fatty liver disease (NAFLD) versus controls. (31)

Is H. pylori Always Harmful?

In short, no.

H. pylori is not harmful for everyone, and it can live in the human gut symbiotically with natural gut bacteria. In fact, H. pylori infects roughly half of the global population and most people don’t know they have it because they don’t have symptoms. There is also some evidence that H. pylori can actually have beneficial effects on individuals with GERD, or acid reflux disease. Studies have shown that the treatment of H. pylori infection in the setting of an ulcer would actually increase GERD symptoms (15).

However, in cases where H.pylori is overgrowing (especially if virulence factors are present), or where it is suppressing stomach acid to the point that it’s causing nutrient deficiencies or overgrowths of other harmful bacteria, yeasts, or parasites in the gut, it should probably be addressed.

Note: This post contains affiliate links. By making purchases through these links, you pay the same amount for products, but a portion of the sale will be sent my way to help with blog expenses. Thanks!

How is H. pylori Diagnosed?

There are multiple tests that your provider can order to confirm if you have H. pylori:

• Urea Breath Test. H. pylori produces an enzyme called urease, which breaks down into ammonia and carbon dioxide. Your provider will instruct you to swallow a pill or drink a liquid that contains urea and then you will blow into a bag and fill it up with air. This tests how much carbon dioxide is exhaled and will determine if you have H. pylori.
• Blood Tests for Antibodies. A blood sample will determine if you have antibodies to H. pylori. However, it does not tell you if you are infected at the current moment, or if you have been infected in the past.
• Upper GI Endoscopy. For this test, you will need to be sedated so that your provider can insert a small camera, called an endoscope, down your throat and into your stomach and into the upper part of the small intestine. A biopsy will be taken to test whether bacteria is present.
• Stool Test. A sample of your stool will be tested to determine if H. pylori is present. Quantitative PCR (DNA based) stool tests like the GI MAP test are extremely sensitive and very likely to detect H. pylori even when other tests do not. (sample report pictured below)

Conventional Medical Treatments for H. pylori

There is not a single treatment for H. pylori. Instead, a combination of 3 to 4 medications are usually prescribed for 10 – 14 days (27, 28). Medications include:

• Antibiotics – a combination of two antibiotic medications – such as clarithromycin, tetracycline, amoxicillin, metronidazole, or sometimes levofloxacin – is typical. Cure rates for various antibiotic combinations vary and have decreased in recent years to around 60-75% due to antibiotic resistance. Some research shows better outcomes when medications are used sequentially (antibiotic A for 1-2 weeks, then antibiotic B for 1-2 weeks) instead of concurrently. A newer antibiotic combination- rifabutin + amoxicillin – has shown promise for those unresponsive to other antibiotic combinations (32).
• Proton Pump Inhibitors (PPIs) such as omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium), lansoprazole (Prevacid), and a few others reduce stomach acid and allow the stomach lining to heal from the damage done by H. pylori. Research shows combining a PPI with two antibiotics (this regimen is called “triple therapy”) increases effectiveness significantly. 
• Histamine (H2) Blockers, such as famotidine (Pepcid) or ranitidine (Zantac) also decrease the amount of acid your stomach makes, but to a lesser degree than PPIs.
• Pepto Bismol (Bismuth subsalicylate) is often added to triple therapy to improve effectiveness based on some study showing success rates as high as 80-85% (this combination is called “quadruple therapy”).

Drawbacks of Conventional Medical Treatment

Four major downsides  of conventional H. pylori treatment should be considered (16, 17, 18).

• Antibiotic resistance – Occurs in about 15-30% of H. pylori cases treated with prescription antibiotics, and rates are rising. Investigation of alternative antibiotics (Rifabutin, etc.) with lower resistance rates show promise, but are not yet widely used in practice.
• Dysbiosis/Bacterial overgrowth – Antibiotics deplete “good” gut bacteria that usually help keep “bad” bacteria and other gut pathogens in check and help build a nice, thick gut lining. When “good” bacteria levels go down, these more harmful organisms can overgrow and Leaky Gut is more likely to develop.
• Yeast overgrowth – When prescription antibiotics deplete beneficial gut organisms, yeast/fungal overgrowths can occur.
• Further suppression of stomach acid – PPIs and H2 blockers can be beneficial short-term, but lowering stomach acid longer term can also lead to downstream consequences like vitamin and mineral deficiencies and bacterial overgrowth. Long term PPI use has also been linked to cancer. 

Natural Remedies for H. pylori

Natural remedies are often used in combination with one another, or are added to prescription antibiotics to improve their effectiveness.

• Zinc carnosine (ZnC), also called polaprezinc known as PepZin GI^TM. ZnC has an antacid effect, anti-inflammatory actions, and soothes the lining of the stomach and intestines. Adding ZnC to triple antibiotic therapy significantly improves effectiveness vs. antibiotics alone (19).  For this reason, zinc carnosine is also used as part of a natural approach to H.pylori.
• Vitamin C and Vitamin E are antioxidants and multiple human studies have shown they significantly increase the effectiveness of standard antibiotic therapy for H.pylori (26).
• Licorice was shown to be 56% effective at eradicating H.pylori in humans when taken for 60 days (26). The deglycyrrhizinated form (aka: DGL) is often used by natural providers because it doesn’t raise blood pressure like regular licorice can.
• Nigella sativa (aka: black seed), combined with omeprazole (Prilosec) was shown in one study to kill H.pylori in 67% of subjects (26).
• Mastic Gum is a natural resin from the trunk branches of the mastic bush and has long been used by natural practitioners to address H.pylori (20). Human studies show mastic gum eradicates H.pylori 30-40% of the time when used alone (26). Eradication rates increase to around 75% when mastic gum is combined with zinc carnosine, probiotics, and other products. (13) The “Gastromend HP” product shown above combines mastic gum with zinc carnosine and DGL.
• Lactobacillus reuteri (“Pylopass”) – This specialized formulation of non-viable (dead) Lactobacillus reuteri probiotics has been shown in small human studies to reduce H.pylori activity and symptoms when used alone or in combination with PPI medications. Both studies showed Pylopass reduced H.pylori by about 66%. Larger studies should be conducted, but this is very promising since Pylopass has no known side effects. (29, 30) The “Gastro-Ease” product shown above combines Pylopass L. reuteri with zinc carnosine.
• Other Probiotic Blends have a low eradication rate when used alone (12-14%), but can significantly improve the efficacy of prescription antibiotics against H. pylori. Strains studied include Saccharomyces boulardii and various Lactobacillus and Bifidobacter strains (22, 23, 24, 25). Read more about why it’s beneficial for you to take probiotics with antibiotics here.

BUY MULTI BIO MAX PROBIOTICS HERE!

BUY OTHER SUPPLEMENTS SHOWN ABOVE HERE!

The following are additional promising holistic therapies for H. pylori, but more research is needed:

• Sulforaphane
• Oregano
• Garlic
• Olive oil
• Honey
• Green tea
• Lactoferrin
• Matula Tea
• Turmeric

Drawbacks of Natural Remedies for H.Pylori:

Natural products have their downsides too, including:

• Not as well studied – A number of studies have been published, far fewer than for conventional treatments. Most studies show promise, but have used low to moderate dosing and shorter interventions (2 weeks) instead of 1-2 months as most holistic practitioners advise.
• May take longer – Natural therapies are often taken for 1-2 months.
• Not covered by insurance – Supplements for natural H. pylori therapy can be pricey, especially considering how long you’ll need to take them.

How to Prevent H. pylori from Coming Back:

The following won’t likely eradicate H. pylori on their own, but are very helpful to optimize digestion to prevent getting H. pylori in the first place, and to help keep it from coming back:

• Reduce your stress – stress suppresses stomach acid, which can give rise to H. pylori overgrowth.
• Eat slowly, mindfully, and without distractions. (Download my free Meal Time Checklist to help with this!)
• Chew your food well.
• Practice good hygiene and sanitation techniques.
• Eat foods high in zinc like wild caught oysters, pasture raised beef and liver, yogurt, and pumpkin seeds. The body needs zinc to make stomach acid.
• Eat bitter herbs (arugula, dandelion greens, etc.) or try bitters supplements with gentian, wormwood, burdock, etc. to stimulate the body to release more stomach acid and digestive enzymes.
• If you know you have low stomach acid and the above isn’t sufficient, ask your provider whether Betaine HCl supplements would help.
• If you take acid suppressing medications (PPIs, H2 blockers, etc.), talk with your provider about alternatives.
• Limit sharing of drinking cups, utensils, etc. since H.p. is passed in saliva.
• Don’t allow pets to lick your face and wash you hands after handling your pet.

About the Author:

Brianna Rivera graduated with a Master’s of Science in Nutrition from the University of Houston, where she is currently completing her dietetic internship. Brianna has strong interests in clinical nutrition, particularly diabetes and gut health. She is passionate about helping people get to the root of their medical issues – Nutrition! In her free time, Brianna loves to travel, be outside in nature, and practice yoga.

Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here. 

References:
Read More