Helicobacter pylori (H. pylori) is a bacterium that infects the stomach. For many people, the infection never progresses and causes no symptoms. However, for others, the bacteria damage the tissues of both the stomach and the duodenum—the first part of the small intestine. Initially, this causes inflammation called gastritis, which then causes ulcers and even cancer.
H. pylori infections are treatable, though the methods change depending on the severity and each person's symptoms and responsiveness to treatments.
Doctors find it very challenging to fully eradicate H. pylori bacteria due to antibiotic resistance and patients failing to follow treatment regimens. Because of this, treatments can be trickier and more involved. The most common first-line treatment is triple therapy.
Doctors use a 14-day course that includes an oral proton pump inhibitor (PPI) and two antibiotics. PPIs are medications that reduce the creation of stomach acid. Triple therapy eradicates H. pylori bacteria in up to 70% of cases.
A more complex—but more effective—treatment option exists for more resilient H. pylori infections. The addition of bismuth improves the eradication rate when the bacteria is antibiotic resilient. Bismuth is a low-toxicity metal with unique anti-inflammatory, antibiotic, and antacid effects.
Some studies find that quadruple therapy increases the H. pylori eradication rate to over 90%.
In recent years, some medical professionals have opted for a “dual therapy” involving five days of a PPI and a single antibiotic, then a sequential five-day treatment of the traditional triple therapy. Initial studies indicated that this could be more effective than standard triple therapy, but additional research efforts have had more mixed results. A similar method also exists, which uses one week of a PPI and a single antibiotic with a second week with more antibiotics at higher doses.
If the first-line therapies are not working, experts may swap out specific antibiotics for other options, assuming the bacteria is resisting the initial medications. The new antibiotics commonly treat tuberculosis, urinary tract infections, and pneumonia, among other conditions. Typically, doctors will still follow a standard triple or quadruple therapy method after replacing the medications.
Histamine is a substance that, among other functions, triggers stomach acid production. Several medications—called histamine blockers—inhibit histamine and stop their processes. If a patient is unable to take PPIs for any reason, experts will typically use histamine blockers in their place.
Usually, PPIs are more effective, but some researchers feel that histamine blockers like H2 receptor antagonists could be better for H. pylori specifically.
Because H. pylori is frequently antibiotic resistant, some experts are utilizing culture-guided therapy. Essentially, technicians test each case’s bacteria for antibiotic susceptibility, often by collecting tissue or stool samples from various areas of the gut. In doing so, they can build a personalized treatment path to more efficiently fight infections. However, areas may not have all of the tools and equipment necessary for this method, and costs are dramatically higher than other therapies.
Additionally, some of the tests for identifying if the bacteria will resist an antibiotic have higher rates of false negatives.
Periodontal therapy, also known as scaling and root planing, may also help with the eradication of H. pylori. In this procedure, a medical professional removes dental plaque and tartar and then smooths the now-exposed surfaces of the dental roots. This removes material that contains plaque, microorganisms, and various toxins.
Because H. pylori also exist in the mouth, researchers are hopeful that this could be a beneficial method to improve the efficacy of other treatment plans. Results are promising, but additional studies are necessary.
Some evidence shows that ingesting lactic acid can suppress H. pylori bacteria, limiting symptoms. In some studies, supplements of yogurt containing these bacteria improved H. pylori eradication rates. Lactic acid bacteria appear naturally in milk products like yogurt, buttermilk, and some cheeses. They are also necessary for the pickling of foods like pickles, sauerkraut, and even some sausages.
While additional research is necessary to confirm the effects, medical researchers have proposed the compound sulforaphane as a potential treatment for H. pylori infections. This compound is naturally present in vegetables like Brussels sprouts, cabbage, broccoli, and cauliflower.
A small amount of evidence from in vivo tests indicates that sulforaphane may also help fight tumors, but these effects have not appeared in clinical trials.
Another potential future treatment path for H. pylori infections could involve a diet including plenty of fatty acids or direct injection of these acids. In vitro studies have shown that fatty acids, like those that appear in plant oils and animal fat, have an antibacterial effect on H. pylori bacteria. Unfortunately, the results remain controversial in tests on living organisms.
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