Helicobacter pylori (H. pylori)
Helicobacter pylori (H. pylori) has been a long-standing companion of humanity for thousands of years. Unlike all other microorganisms, this minuscule, spiral-shaped bacterium possesses an uncanny ability to survive in our stomachs. It can also inhabit the oral cavity. While in some people it may silently coexist, in others, it awakens with a vengeance, causing a host of symptoms. Human infection with this bacterium is a worldwide occurrence. In developing countries, the infection rate reaches as high as 70–80% of the population, while in highly developed countries, it ranges from approximately 1.2% to 13% of the population (Palateiro et al., 2014).
In this blog, we will unravel the pathological conditions caused by H. pylori infection, their associated symptoms, delve into conventional treatment, and discuss the challenges that this treatment may provoke.
The Silent Guest: H. pylori Bacterium
In most instances, H. pylori infection operates discreetly, leaving no trace of its presence (asymptomatic infection). Furthermore, some individuals may experience mild gastritis or a vague sense of stomach discomfort. However, in a certain percentage of those infected (from 15%-20%), the complex and dynamic immune reaction of the host to this pathogenic bacterium triggers the development of the disease, which results in inflammation of the stomach, significantly increased secretion of gastric acid, atrophic gastritis and the appearance of ulcers on the stomach or duodenum.
What’s even more concerning is that in 1994, the World Health Organization classified Helicobacter pylori as a human carcinogen. Approximately 1% of those infected face an alarmingly high risk of developing gastric adenocarcinoma and MALT lymphoma. Among all malignant diseases, gastric cancer holds the second position worldwide in terms of mortality rate (Kusters et al., 2006).
Recognizing the potential danger, it is essential to initiate treatment when the first symptoms of the infection appear, such as upper abdominal pain, heartburn, dry cough, flatulence, loss of appetite, nausea, or bad breath. Other indicators to do the testing and therapy may include indigestion, thrombocytopenia, anemia, vitamin B12 deficiency, or a family history of gastric cancer and MALT lymphoma. In recent years, researchers have also linked H. pylori infection to hepatitis, insulin resistance, type 2 diabetes, colon cancer, bile duct cancer, dementia, psoriasis, and chronic urticarial (Gravina et al., 2018).
H. pylori Infection Treatment: A Multi-Pronged Approach
Treatment of H. pylori infection typically aligns with the guidelines of the American College of Gastroenterology (Crey, 2017), which is generally accepted worldwide. It combines two or three antibiotics with adjuvant agents like proton pump inhibitors (PPIs) and probiotics. The antibiotic selection comprises amoxicillin, tetracycline, metronidazole, furazolidone, levofloxacin, and clarithromycin (Wannmacher, 2011).
The first-line antibiotic therapy involves standard triple therapy, which primarily includes:
- Double-dose PPI twice a day
- Clarithromycin 500 mg twice a day
- Amoxicillin 1000 mg twice a day
For those who are allergic to penicillin, the recommended first line therapy is:
- Double-dose PPI twice a day
- Clarithromycin 500 mg twice a day
- Metronidazole 400 mg three times a day
If the first-line therapy proves ineffective, triple therapy with a fluoroquinolone antibiotic like levofloxacin is recommended:
- Double-dose PPI twice a day
- Amoxicillin 1000 mg twice a day
- Levofloxacin 250 mg twice a day or 500 mg once a day
Alternatively, bismuth quadruple therapy can be considered:
- Double-dose PPI twice a day
- Bismuth four times a day
- Metronidazole 400 mg three times a day
- Tetracycline chloride 500 mg three times a day or amoxicillin 1000 mg twice a day
These treatments are typically administered for 14 days or more.
To mitigate the unwanted side effects of antibiotics, probiotics are recommended alongside antibiotic treatment for H. pylori infection.
The Achilles’ Heel: Challenges of Antibiotic Therapy
The widespread use of antibiotic therapy in the battle against H. pylori infection has triggered a concerning rise in antibiotic resistance. As a result, the first-line antibiotic therapy is unsuccessful in approximately 20% of cases, and this percentage continues to climb, with some patients remaining uncured even after repeated cycles of various antibiotic therapies. Consequently, the World Health Organization listed H. pylori as a bacterium highly resistant to existing antibiotics, emphasizing the need for novel, effective, and targeted therapies (WHO, 2017).
Moreover, antibiotic therapy is usually accompanied with negative side effects, including diarrhea, nausea, vomiting, and stomach pain, making the medications challenging to endure and leading many patients to discontinue treatment. Additionally, prolonged antibiotic therapy disrupts the diversity and quantity of “beneficial” bacteria in the intestinal tract, crucial for normal intestinal function. This can also pave the way for the colonization of the intestines by Candida fungi, potentially resulting in the challenging-to-treat condition of candidiasis. In severe cases, infection with Clostridium difficile can occur (Adamsson et al., 1999).
Exploring Alternatives: The Quest for Effective H. pylori Treatments
Beyond antibiotics, attempts have been made to introduce alternative treatments for H. pylori, involving microorganisms, peptides, polysaccharides, or ultraviolet radiation. Regrettably, these alternative approaches have not proven effective (Ayala et al., 2014). Additionally, endeavors to develop an H. pylori vaccine have yielded unsatisfactory results (Sutton & Boag, 2019).
Probiotics: Allies in H. pylori Treatment
Considering that certain probiotic bacteria can demonstrate antibacterial activity by producing substances like lactic acid and inhibiting bacterial attachment to surfaces, efforts have been made to employ probiotics in eradicating H. pylori infection. Studies indicate that supplementing triple antibiotic therapy with the probiotic bacterium Saccharomyces boulardii slightly improves the eradication rate while reducing antibiotic side effects (Szajewska et al., 2010). Similarly, adding the probiotic bacteria Lactobacillus GG to triple therapy does not impact the eradication rate of H. pylori infection but does alleviate the negative effects of antibiotic therapy (Armuzzi et al., 2001). These findings suggest that probiotics can complement standard antibiotic therapy, primarily by mitigating its adverse effects
Herbal Preparations: Nature’s Gift in H. pylori Treatment
A significant number of people are interested in natural treatments for Helicobacter pylori infection. There are some herbal dietary supplements in the market that are recommended for patients with H. pylori infection. These supplements are typically based on plant extracts known for their anti-inflammatory activity or their ability to improve digestion. Thus, they can successfully alleviate symptoms of the infection or mitigate the adverse effects of antibiotic therapy. They are generally considered complementary additions to standard therapy, not replacements.
Introducing essential oils: A Herbal Solution for H. pylori infection
Herbal solution based on blend of essential oils made of Wild Oregano, Summer Savory and Thyme is proven to be effective in suppressing H. pylori infection (Nikolić et al., 2023). This innovative solution harnesses the power of essential oils extracted from aromatic plants. Scientifically validated, these essential oils eliminate H. pylori directly, acting locally on the gastric mucosa. Simultaneously, essential oils exhibits anti-inflammatory properties, reducing stomach mucosa inflammation triggered by elevated stomach acid levels.
Concluding Thoughts on H. pylori infection
Managing Helicobacter pylori infection is a multi-dimensional challenge, demanding a delicate balance between effective eradication and minimizing unwanted side effects. While antibiotic therapy remains a cornerstone of treatment, the specter of antibiotic resistance and its associated drawbacks prompt exploration of alternative solutions. Blend of essential oils made of Wild Oregano, Summer Savory and Thyme stands as an innovative herbal formulation, offering hope for those seeking natural alternatives to conventional antibiotics. As research into H. pylori treatment continues to evolve, we can anticipate a future where this bacterium no longer looms as a menacing health threat.
Author: Dr. Nataša Simin, PhD in Biochemistry
References cited in the text:
Adamsson et al. (1999): Comparative effects of omeprazole, amoxycillin plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients. J Antimicrob Chemother, 44:629-40.
Armuzzi et al. (2001) The effect of oral administration of Lactobacillus GG on antibiotic-associated gastrointestinal side-effects during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther, 15:163-9.
Ayala et al. (2014) Exploring alternative treatment for Helicobacter pylori infection. Word J Gastroenterol, 20:1450-1469.
Chey et al. (2017) ACG Clinical Guideline: Treatment of Helicobacter pylori Infection, American Journal of Gastroenterology, 112:212-239.
Gravina et al. (2018) Helicobacter pylori and extragastric diseases: A review. World Journal of Gastroenterology, 24:204–3221.
Kusters et al. (2006) Pathogenesis of H. pylori infection. Clin Microbiol Rev, 19:449–490.
Nikolić et al. (2023) Savory, oregano and thyme essential oil mixture (HerbELICO®) counteracts Helicobacter pylori. Molecules, 28(5):2138. https://doi.org/10.3390/molecules28052138
Palateiro et al. (2014) Prevalence of Helicobacter pylori infection worldwide: a systematic review of studies with national coverage. Dig Dis Sci, 59:1698-709.
Sutton & Boag (2019) Status of vaccine research and development for Helicobacter pylori. Vaccine, 37:7295-7299.
Szajewska et al. (2010) Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther, 32:1069-79.
Wannmacher (2011) Review of the evidence for H. pylori treatment regimens. 18th Expert Committee on the Selection and Use of Essential Medicines.
WHO, 2017 “Global priority list of antibiotic-resistant bacteria to guide research, discovery and development of new antibiotics”