Helicobacter pylori is a bacteria that resides in the digestive tracts of over two-thirds of the world's population. A higher prevalence of infection is noted in developing countries, people of low socioeconomic status, and the Hispanic and African American populations. This bacteria is often found in the stomach of infected individuals and may contribute to inflammation, ulceration, and an increased risk of stomach cancer. Therefore, it is important to consult with a healthcare provider for appropriate management if symptoms are present. This article will discuss H. pylori infection and considerations for testing and managing the infection. (1, 10)
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What Is H. pylori?
Helicobacter pylori (H. pylori) is a spiral-shaped bacteria found in the gastrointestinal (GI) tract, commonly the stomach, of up to 75% of people globally. Most people don't know they have H. pylori because they never develop symptoms. However, in some individuals, an infection can contribute to significant GI symptoms, peptic ulcer disease (PUD), gastritis, and stomach cancer. (1, 2)
H. pylori Symptoms
Although it's not fully understood why, up to 90% of people with H. pylori infection will never have any signs or symptoms. When symptoms do occur, they are typically related to gastritis (inflammation of the stomach lining) or a peptic ulcer (a sore within the lining of the stomach or small intestine) and may include (1):
- Burning abdominal/stomach pain
- Nausea and vomiting
- Loss of appetite
- Frequent burping
- Heartburn, reflux, or GERD
- Gas and bloating
- Unintentional weight loss
- Black or bloody stools caused by bleeding ulcers
What Causes H. pylori?
H. pylori infection occurs when the bacteria is spread from one person to another, typically during childhood, through direct contact with stool or saliva. Because of this, person-to-person transmission is common within families. H. pylori may also be spread through contaminated food or water. Once the H. pylori bacteria has gained access to the stomach, it uses its various virulence factors (cellular structures and molecules) to burrow into the stomach's lining and may contribute to gastric inflammation. (1)
Hypochlorhydria, or low stomach acid, may increase the risk of H. pylori infection because it creates a welcoming non-acidic environment in the stomach, allowing bacteria to adhere to the stomach wall more easily.
How Is H. pylori Diagnosed?
Per the American College of Gastroenterology (ACG) guidelines, screening for H. pylori infection should be performed in patients with an active or past history of PUD, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, gastric cancer, and indigestion (5).
Endoscopic culture and biopsy of the stomach mucosa can be used to diagnose H. pylori infection. Given this procedure's cost and invasive nature, it is typically reserved when endoscopic imaging is indicated for other reasons.
The urea breath test is the most accurate non-invasive testing method for diagnosing H. pylori infection. The breath test involves the patient collecting a baseline breath sample, swallowing a urea-containing pill or liquid, and collecting a second breath sample 15 minutes later. The breath test measures and compares the carbon dioxide levels in each sample to determine the presence of infection. To prevent false negative results, patients should discontinue antibiotics and bismuth compounds for at least four weeks and proton pump inhibitors and sucralfate for at least two weeks before testing. (3)
A stool antigen test is another popular non-invasive testing method. It is cheaper than the urea breath test but slightly less accurate (3). This test measures immunogenic proteins (antigens) in the stool that are associated with H. pylori infection. Like the breath test, antimicrobials, proton pump inhibitors, and bismuth preparations can lead to a false-negative result; patients should discontinue these for at least two weeks before performing the test.
A serum IgG antibody test is the third non-invasive diagnostic test for H. pylori. This test cannot distinguish between an active and past infection and has the lowest accuracy rate. It may be recommended for patients with PUD or who cannot stop taking medications that affect the accuracy of breath and stool testing. (4, 5)
Functional Medicine Labs That Help Individualize Treatment for H. pylori Patients
Functional medicine labs help providers thoroughly assess GI health, rule out factors contributing to GI inflammation and symptoms, and customize H. pylori management for maximum efficacy.
Comprehensive Stool Test
A comprehensive stool test can holistically assess gastrointestinal health and function to adjunctively support gut healing and a balanced microbiome as needed and indicated by results.
The GI-MAP by Diagnostic Solutions is a popular stool testing option among functional medicine providers specifically for assessing and managing H. pylori. This panel includes DNA detection and quantification of H. pylori microbes, virulence factors, and antibiotic-resistant genes. The presence or absence of virulence factors and antibiotic resistance can change management option decisions to assist in the timely and successful management of infection.
Blood Tests for Hypochlorhydria
If hypochlorhydria is suspected or determined as a contributing factor to H. pylori infection, ordering a panel that includes a CBC, CMP, iron panel, thyroid panel, vitamin B12, intrinsic factor, and anti-parietal cell antibodies can screen for causes and consequences of low stomach acid.
Food Sensitivity Testing
Food sensitivities may contribute to gastrointestinal inflammation, exacerbating abdominal pain and other symptoms of H. pylori-induced gastritis and PUD. Antibody testing identifies foods to which an individual is sensitive so that they can temporarily remove them from the diet to help manage symptoms and support the gut-healing process.
SIBO Breath Testing
Proton pump inhibitor (PPI) therapy is a mainstay treatment for H. pylori management, gastritis, GERD, and PUD. PPI use and hypochlorhydria are risk factors for small intestinal bacterial overgrowth (SIBO), which may contribute to low-grade GI and systemic inflammation and upper GI symptoms. SIBO can be assessed with an at-home breath test.
Conventional Management for H. pylori
Management should be initiated for all patients who test positive for active H. pylori infection. Standard conventional first-line antibiotic protocols for managing H. pylori include (5):
- Clarithromycin triple therapy: PPI, clarithromycin, and amoxicillin or metronidazole for 14 days
- Bismuth quadruple therapy: PPI, bismuth, tetracycline, and metronidazole or tinidazole for 10-14 days
- Concomitant therapy: PPI, clarithromycin, amoxicillin, and metronidazole or tinidazole for 10-14 days
Functional Medicine Management Protocol for H. pylori
Nonprescription approaches usually have fewer side effects than antibiotics, are less likely to cause treatment resistance, and may be effective when combining multiple natural agents. A dietary and natural supplement protocol for H. pylori management is described below.
Therapeutic Diet and Nutrition Considerations for H. pylori
No universally suggested diet is known to expedite the management of H. pylori. While preliminary research suggests a low-nickel diet may increase management rates in patients receiving antibiotic therapy, additional research is required to confirm this result. Otherwise, a well-balanced, whole-food diet is recommended to prevent nutritional deficiencies that may occur secondary to H. pylori infection and hypochlorhydria, including vitamins B12, C, E, and iron. (1)
Patients with identified or suspected gastritis or PUD could benefit from a 6-8 week elimination of food sensitivities and allergies to remove triggers exacerbating intestinal inflammation. During an elimination-rechallenge diet, food triggers should be removed for an allotted time and then individually reintroduced into the diet over a three-day challenge. The patient should be instructed to eat an average-sized serving of food in its purest form three times on the first day of the food challenge and then re-eliminate it for two days. During these two days, the patient will observe for any symptoms indicating an adverse reaction to the food. If no symptoms occur, the patient can reincorporate the food into the diet.
Foods rich in fiber, antioxidants, and flavonoids (e.g., whole fruits and vegetables) may support the mucosal lining of the GI tract, potentially reducing rates of peptic ulcers and supporting the gut-healing process. (8, 9)
Supplements Protocol for H. pylori
The sample protocol below explains botanical and nutritional supplements frequently considered for the natural management of H. pylori infection.
Pyloricil
Orthomolecular's Pyloricil formula combines four natural ingredients known to support stomach health.
Mastic gum, obtained from the stem and leaves of the mastic tree (Pistacia lentiscus), has been used historically to support stomach health. Laboratory and clinical studies have explored its potential effects on H. pylori infection.
Bismuth is a naturally occurring mineral commonly utilized in conventional and functional medicine protocols because it may support the management of H. pylori and help maintain healthy stomach lining. H. pylori resistance against bismuth has not been reported.
When complexed with carnosine, zinc's properties are enhanced. Zinc carnosine has been used as an anti-ulcer agent for decades. Because of its anti-inflammatory, antioxidant, and mucosal-supporting properties, its use has been extended to supporting H. pylori, GERD, oral mucositis, esophagitis, ulcerative colitis, and hemorrhoids.
Berberine is a botanical extract found in various plants, including Oregon grape root (Berberis aquifolium), barberry (Berberis vulgaris), and goldenseal (Hydrastis canadensis). It has been studied for its antimicrobial and anti-inflammatory properties and may be effective in supporting H. pylori management when used in conjunction with other therapies.
Dose: 2 capsules twice daily
Duration: 8 weeks
Probiotics
A probiotic supplement may help reduce the side effects of antibiotic therapy and support infection management. Many probiotic strains have been studied successfully as part of a management protocol, including species of Lactobacillus, Bifidobacterium, Saccharomyces boulardii, and spore-based probiotics. (6, 7)
Dose: per label instructions
Duration: 8 weeks
Lactoferrin
Lactoferrin is a protein found in mammalian milk that may enhance immunity and has been studied for its potential to improve the efficacy of H. pylori management strategies.
Dose: 300mg once daily
Duration: 8 weeks
When to Retest Labs
Natural H. pylori protocols should be performed for eight weeks before retesting with either breath or stool testing to assess H. pylori management.
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Summary
This article discussed the frequency and potential consequences of H. pylori infection. Because conventional management involves multiple pharmacologic agents for extended periods, many people seek functional and integrative medical care for alternative means to support infection management. The dietary and supplemental measures discussed in this article can be used to guide practitioners in creating effective natural management regimens for H. pylori infection.
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