Do you suffer from heartburn, reflux or burping? Perhaps you rely on a medicine to help settle your tummy. I have written on digestive disorders on several occasions previously, but this time I would like to write specifically on a little bacterium called Helicobacter pylori. Helicobacter pylori bacterial infection is recognised as the most prevalent bacteria to infect the human population in the entire world. You may well identify the following problem, and if you do, don't despair. It actually is possible to free from heartburn, reflux or a low grade queasiness, which affects so many people.

Helicobacter is a clever little bug

In 1982, when Australian Dr. Barry Marshall identified a new bacterium called Helicobacter pylori (HP) as an infectious agent responsible for peptic ulcer disease, it completely transformed medicine's understanding of the microbiology and disease of the human stomach. Your stomach is protected from its own gastric juice by a thick layer of mucous that covers the stomach lining. HP takes advantage of this protection by actually living in the mucous lining. Once this clever little bug is safe in this mucous, 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 (alkaline) bases. This creates a cloud of acid-neutralizing chemicals around the H. pylori, protecting it from the acid in the stomach. This cloud is also part of the reflux and burping process that occurs, which many HP people complain of.

Contributing to the protection of HP is the fact that the body's natural defenses cannot reach these bugs in this mucous lining of the stomach. The immune system will respond to an HP infection by sending "killer T-cells", (white blood cells), and other infection-fighting agents. However, these potential H. pylori eradicators cannot reach the infection, because they cannot easily get through stomach lining. They do not go away - the immune response just grows and grows over time. White cells die and spill their destructive compounds onto cells lining the stomach lining. More 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 in the lining of your tummy. And of course, the person who suffers is often blissfully unaware, takes an antacid or an acid-blocking drug long-term, and continues to eat and drink foods which only aggravate the healing process long term. So they go back to the doctor, only to be told to stay on the medicine. After a few years, the person resigns themselves to the fact that they will always require this "medicine" to cure their condition. Yeah right, and Alice lived happily after in Wonderland.

To confirm that HP caused the gastritis and peptic ulceration, Marshall swallowed cultures of the bacteria and contracted gastritis (inflammation of the mucus membrane of the stomach). He then  underwent endoscopy (internal examination of the stomach), and provided biopsies from which the suspected bug was re-isolated.

Changing medical belief and practice takes time. For nearly 100 years, scientists and doctors thought that ulcers were caused by lots of stress, spicy foods, and copious alcohol. Treatment involved bed rest and a bland and boring diet. Later, researchers added stomach acid to the list of causes and began treating ulcers with antacids when they became fashionable. Unfortunate for poor Barry, nobody believed him. In fact, he was actually treated with ridicule and disdain when he first proposed the idea that a bacteria actually lived the hostile environment of the stomach. Before 1982, the accepted medical paradigm was "no acid, no ulcer", and that stomach ulcers only occurred when excess acid damaged the stomach wall and that all treatment should be aimed at reducing or neutralising all that bad acid. Surely you remember the advertisements on TV with the man drawing on his tummy with a felt tipped pen, telling you that the acid has to "stay down there". These commercials generally came on after dinner, the time when your tummy is most likely to play up, I can't help but thinking how many of those sufferers possibly have an undetected H.pylori infection. There is still a lot of drug promotion regarding this acid reflux problem. Unfortunately, many such patients today are still seen as having "too much stomach acid", and treated with antacids or stomach-acid blockers as front-line therapy, when in my clinical experience actually the opposite applies, they don't have enough or have an infection which needs sorting. 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, and it took an Aussie GP to prove all the world's experts wrong.

It seems pretty silly to treat the acid problem perpetually, without enquiring into actually why this burping, reflux and upper abdominal discomfort is occurring in the first place.  Albert Szent Györgyi, (1937 Nobel Laureate in Physiology and Medicine) said that: "Discovery consists of seeing what everybody has seen and thinking what nobody has thought." Today it is an established fact that most cases of peptic ulcers and gastritis, diseases that affect millions of humans worldwide, result from this HP infection, and not "too much acid" in the stomach at all.

"Discovery consists of seeing what everybody has seen and thinking what nobody has thought."  Albert Szent Györgyi

HP infection and prevalence

H. pylori is believed to be transmitted orally. Did you wash your hands? Many researchers believe that HP is transmitted orally by means of fecal matter through the ingestion of 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, all common symptoms of gastritis. The bacterium could then be transmitted through oral contact.

HP infection remains a huge problem, is extremely common and infecting more than a billion people worldwide. It is estimated that half of the American population older than age 60 has been infected with H. pylori at some stage and the economic effect of ulcer disease in the US (as measured back in a study of 1989 data) showed that the illness cost then nearly $6 billion annually. ($2.66 billion for hospitalisation, not including doctor 's fees), outpatient care ($1.62 billion), and loss in work productivity ($1.37 billion).
One in five Aussies and Kiwis have HP, according to Dr. Barry Marshal, infection usually persists for many years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients with gastric and duodenal ulcers. You can imagine what this common complaint in NZ and Australia is costing, in terms of medication, doctor's visits and lost productivity at work. Early research on HP characterised much of the work to come, the data that emerged from the study of all these samples was quite unexpected. It showed that HP is actually a common bacterial agent and that an amazing 30-50% of the world's population are colonised with it.

How do you know if you have the HP bug?       

The infection manifests differently in different individuals. In some people, it produces more acid in the stomach, and ulcers may result. In others, stomach acid suppression or complete lack (which we call achlorhydria) may result, and these people may be at a greater risk of gastric cancer. It is unclear why some people respond one way or the other.

Typical manifestations of a Helicobacter pylori infection:

• Nausea, or a low-grade feeling of being queasy. Could be vomiting.
• Avoidance of chilli, garlic or a specific food which "does not agree" with your tummy.
• Bloating worse after meals. Feeling worse after meals or certain foods.
• Recurring abdominal pain, intestinal cramps.
• Peptic or duodenal ulcers (over 90% of all cases have HP)
• Burping, this can be pretty bad. The person may have developed a reputation!
• Heartburn, and perhaps reliant on Quick-Eze or Gavascon, Losec, etc.
• Diarrhea or constipation after several years of infection.
• Disturbed sleep, perhaps waking up with a hollow feeling or heartburn. I have known some patients to prop up the head of the bed with a few bricks even.
• Symptoms worse at night, or worse lying down.
• Vitamin B12 deficiency. Have your practitioner test for this, you may well be deficient.
• Altered appetite, some times you may feel like eating, other times you don't.
• After being infected for several years, you may have develop mineral deficiencies which can lead to a myriad of health problems.
• Helicobacter pylori is implicated in Hashimoto's thyroiditis.
• Migraine headaches (40% of migraine sufferers are positive, and eradication subsides the headaches).
• Acne rosacea. Helicobacter pylori is suspected of causing rosacea (eradication of HP often results in a significant reduction in rosacea symptoms).

Is it any wonder how an ailing stomach is supposed to do its job, i.e., digesting and absorbing foods efficiently when a bacterial infection is causing such dysfunction? Your doctor may have initially prescribed a medicine such as Losec, Gavascon or Mylanta for your stomach, serving to block acid or dilute it. How is your tummy supposed to work at all now? Then you go back and complain that the symptoms are unchanged. What then? You can see what I mean, after many years of this infection you can feel quite unwell. I see one person or more each week like this, and have done so for many years. When I wrote an article to our local newspaper several years ago regarding HP, I received nearly ten calls. And almost al these patients had a HP infection, all were on either Losec, Quick-Eze, Gavascon or Mylanta.

Please note that it is extremely important to obtain an accurate diagnosis before trying to find a cure of your heartburn or reflux.  Many stomach or digestive diseases and conditions share common symptoms: if you treat yourself for the wrong illness or a specific symptom of a complex disease, you may delay legitimate treatment of a serious underlying problem, yes even stomach cancer.  In other words, the greatest danger in self-treatment may actually be self-diagnosis. Always work with your health-care professional, preferably one who is experienced in gastrointestinal disorders. If you do not know what you really have, you simply can not treat it! 

I have always had a great concern regarding the extensive use of antibiotic drugs required to treat HP infected individuals. The conventional medical clearing of HP from the stomach requires therapy from 10 to 14 days with multiple drugs. My concern is that prolonged or recurrent antibiotic treatment alters the normal microbial population of the entire gastrointestinal tract, eliminating many beneficial bacteria as well as HP, allowing the sufferer to develop a gut environment which may contain bugs like Candida albicans, proteus, or a whole host of other undesirables. You get rid of one problem, only to create yet another.

Triple Therapy

The use of only one medication to treat H. pylori was never recommended by Dr. Marshall. At this time, the most conventional treatment is a 2-week course of treatment called "triple therapy". It involves taking two antibiotics to kill the bacteria and either an acid suppressor or stomach-lining shielding drug. Two-week triple therapy reduces ulcer symptoms, kills the bacteria, and prevents ulcer recurrence in many patients - but the recurrence can be as high as 75%. Complete eradication is difficult, I have had many patients who have come to me after having had triple therapy many years ago with average to poor results, and were plonked on an acid blocker for many years after.I do recommend this for some resistant cases, and have been know to send some patients to a GP for triple therapy, then follow-up with natural treatment for 6 weeks. I have found that some patients may find triple therapy complicated because it involves taking 3 kinds of drugs, and as many as 20 pills a day. Also, the antibiotics and bismuth drugs used in triple therapy may cause side effects such as nausea, vomiting, diarrhea, dark stools, metallic taste in the mouth, dizziness, headache, and yeast infections, particularly in women.

HP Testing

The diagnosis of H. pylori infection has traditionally involved endoscopy with biopsies of the stomach's mucosa. There are three ways to test for HP currently. To be honest, I only occasionally authorise a HP test these days, and generally have a "gut feeling" a person has this bug once they come into my room and complain of the above mentioned symptoms. Common sense - the patient will soon tell you if they are or are not improving, and it only takes about three to four weeks to really know what is going on. Just because the test results come back negative, you could still have this bug. You know me by now, please don't get paralysis from analysis! If you feel significantly better after a HP treatment whether it be pharmaceutical or natural  - you probably have HP regardless of what the test results say. Remember - up to one in five Kiwis and Aussies have this infection, so the odds are reasonably high you may have it.

• The Urea Breath Test method of diagnosis relies on the Urea reaction being present, as mentioned earlier. This is a sound test - 90 - 95% successful in picking up the HP bug.
• Blood tests measuring HP antibody levels have been developed. However, these tests have suboptimal sensitivity and specificity (85% and 79%).
• Stool tests for antibodies - again, many factors can affect the outcome of this test, stay with breath testing. Many experts say that the fecal antigen test is bullet proof, but in my experience I have seen many "false negatives" with testing. That is, the results come back all ok, but the patient responds dramatically after HP treatment.
  

Natural HP Eradication

No clear indications exist for specific treatment of each and every individual case of HP associated gastritis. I have found the following treatments to be effective, and employed many different therapies over the years. Here are some treatments which I have found to work in various HP cases. Remember, recurrence rates are quite high, so you may want to persist with treatment until you feel much better, then hang in there for a few more months (lower grade treatment) to be absolutely sure. I recommend treatment in blocks of 6 weeks, then wait 2 -3 weeks, then another 6 week period of treatment. A good clinical tip for you: always treat this infection by taking something with meals, and also something in-between, or away from foods. This is designed to really drive the "kill" treatment home, and lets the treatment have access to the HP bugs in the gut with as well as away to some extent from foods and gastric juice involvement. I have a saying in my clinic: persistence breaks resistance. Remember Winston Churchill? - never give in, never give in, never give in.

• Manuka honey, which has high levels of hydrogen peroxide and has been shown in studies to be active against H. pylori. Go for the Comvita high UMF factor Manuka honey.
• Propolis works really well for some, but is dismal for others.
• Vitamin B12 - get this checked in your blood! You may well be deficient here.
• After antibiotic treatment is finished, (triple therapy) it makes sense to rebuild the gut flora with lactobacillus species. They won't cure the condition, however. (A 2002 trial demonstrated that a mixed acidophilus preparation failed to eradicate the H. pylori infection in the patients upon whom it was tried).
• DGL (deglycyrrhizinated licorice) - you can get this in capsules or liquid.
• Aloe Vera helps to heal the mucous lining of the gastrointestinal tract.
• Berberine is found in the herb Goldenseal, and it may be used as a natural herbal antibiotic.
• Eat grapefruit seeds, for some this is very effective long term. The extract is even better (GSE).
• Digestive enzymes may also be useful - especially with achlorhydria (low stomach acid)
• Gum mastic is a natural substance from the sap of the Mediterranean evergreen tree, Pistacia lemniscuses. Mastic gum has been shown to be effective in protecting the digestive system, healing peptic and duodenal ulcers, and eradicating H. pylori from the gut. I use this a lot, and give two capsules twice daily in between meals.
• Bismuth. It displays anti-inflammatory action (due to salicylic acid) and also acts as an antacid and mild antibiotic. Don't freak out - It can also cause a black tongue and black stools in some people who take it, when it combines with trace amounts of sulfur in their saliva and gastrointestinal tract. This discoloration is temporary and absolutely harmless.

My favourite HP treatment regime? I would have to say gum mastica between meals, and with meals a preparation of Bismuth, deglycyrrhizinated licorice,grapefruit seed extract and goldenseal. I often recommend aloe vera, Lactoferrin and activated charcoal as well.

Do you get that annoying heartburn, and want to try and find a cause and ultimately a cure? Consult your naturopath or nutritional-friendly doctor who can check you out carefully and thoroughly and who will actually treat the cause, not the symptom. They should generally recommend a course of treatment and a specific diet designed for the individual, with promising results for many patients. And what a relief, to be free of heartburn, bloating and that "awful feeling in the tummy" again!

References

• The American College of Gastroenterology (American Journal of Gastroenterology, 1997, volume 92, pages 614-620)
• The Archives of Internal Medicine 1997, volume 155, pages 922-928.
• English, J., et al.  New research links H. pylori infection and gastric cancer.  Vitamin Research News.  15(11), 2001.
• Graham, D. Y.  Helicobacter pylori:  its epidemiology and its role in duodenal ulcer disease. Gastro Hepatol.  6:105-110, 1991.
• Csendes, A., et al.  [Presence of Helicobacter pylori in the duodenum, antrum, and fundus in control subjects and patients with duodenal ulcer, gastric ulcer, gastritis, or erosive duodenitis. Histological analysis of 357 subjects].  Rev Med Chil.  123(2):177-184, 1995.
• Sinclair, S., et al.  Migraine headaches: nutritional, botanical and other alternative approaches.  Alternative Medicine Review.  4(2):86-95, 1999.