H Pylori Treatment
Helicobacter pylori is a commonly found infection throughout the world. In this article, I will be going discussing the most common H pylori treatment, reveal the dark secret about Helicobacter pylori treatment, and discuss a new cutting edge treatment which is showing great success in clinical trials.
Do You Need An H Pylori Treatment
Even if you do not have stomach ulcer symptoms, treatment for an H pylori infection is usually necessary. Ulcer or not, H pylori infections significantly increase your risk of getting gastric cancer.
It is much easier to treat an H pylori infection than it is to treat stomach cancer or even an ulcer, and prevention is ideal.
The Current Treatment for H Pylori
While different physicians may use different approaches, the vast majority of patients diagnosed with an H pylori infection will find themselves being put on the so-called triple therapy plan. This involves:
- Two antibiotics – typically amoxicillin and clarithromycin
- An acid-reducer or proton pump inhibitor – typically pantoprazole
Sometimes different antibiotics are used based on your treatment history. The antibiotics usually run a 10-day course.
The Dark Secret of Triple Therapy
The problem with triple therapy is that H pylori, like any good bacterium, has begun to develop resistance to these antibiotics. According to researchers, triple therapy success rates for curing H pylori are falling on a year-by-year basis and current success rates have fallen under 80% (1).
This means that over 20% of patients who run through triple therapy will still have H pylori. This is an extremely low rate of success given that modern medicine is able to cure common bacterial infections with nearly 100% success in the majority of cases.
While triple therapy is likely to be used for quite a few more years, it would be a good question to ask your doctor about. A physician who keeps up with the literature will frequently recommend a follow-up test somewhere around 6-12 weeks out to double-check for H pylori eradication.
Enter Sequential Therapy
Over the last several years, a new approach to H pylori treatment has been under clinical testing called sequential therapy. Rather than giving all three drugs at once, researchers and clinicians have demonstrated higher success rates by splitting up the antibiotics rather than having them all taken at once (1).
While not yet mainstream, over the coming years this is likely to become a more prevalent form of Helicobacter pylori treatment as the resistant-strains of become more common.
A Cutting-Edge H Pylori Treatment
A very interesting study out of China could represent the future of Helicobacter pylori treatment. In this study, researchers found that different medicines had different levels of efficacy based on the genes of the participants (2).
Patients with a certain gene mutation had higher success rates using a different prescription drug as compared to the rest of the patients in the study. This is
a very exciting discovery, and while not feasible yet, it certainly foreshadows what might not only be the future of H pylori treatment but also the future of medicine itself.
H Pylori As A Protector?
In very recent research, scientists have begun postulating that in the absence of an ulcer, H pylori might actually not be a world-wide menace. H pylori is thought to have colonized humans for an upwards of 50,000 years, and there is the possibility that we have adapted to its presence (3).
Furthermore, researchers have discovered the H pylori, in certain populations, acts as an stomach acid suppressant (4). Researchers have even implicated that not being infected with H pylori is actually a risk for gastroesophageal reflux disease, also known as GERD (5). Treating H pylori and taking out the bacteria, may actually cause the patient to develop GERD (for those that do not know, GERD is chronic heartburn). GERD is very unpleasant in the short term and linked to esophageal damage and cancer in the long term.
Some scientists are now advising that populations at risk for GERD actually not receive H pylori treatment as long there is no ulcer or symptoms from H pylori infection (5). Other researchers have suggested that if H pylori is in the stomach, it is protective of GERD, but it colonizes the esophagus, it creates inflammation and should be eradicated (6).
Despite this evidence, I believe the data is too controversial to make any hard decisions on. To summarize the findings, if you have an ulcer, experience gastritis or any H-pylori related symptoms and have been diagnosed with H pylori, you will still want to receive H pylori treatment.
Perhaps it is debatable if adults with GERD who are otherwise healthy should receive H pylori treatment, but more research needs to be done on this topic before becoming mainstream practice.
1. Vaira D et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: A randomized trial. Ann Intern Med 2007 Apr 17; 146:556-63.
2. Zhang L, Mei Q, Li QS, Hu YM, Xu JM. The effect of cytochrome P2C19 and interleukin-1 polymorphisms on H. pylori eradication rate of 1-week triple therapy with omeprazole or rabeprazole, amoxycillin and clarithromycin in Chinese people. J Clin Pharm Ther. 2010 Dec;35(6):713-22.
3. Atherton J.C. & Blaser MJ. Coadaptation of Helicobacter pylori and humans: ancient history, modern implications. J Clin Invest. 2009 Sep;119(9):2475-87.
4. Ghoshal U.C. & Chourasia D. Gastroesophageal Reflux Disease and Helicobacter pylori: What May Be the Relationship? Neurogastroenterology & Motility. 2010 Jul;16(3):243-50.
5. Chourasia D, Misra A, Tripathi S, Krishnani N, Ghoshal UC. Patients with Helicobacter pylori infection have less severe gastroesophageal reflux disease: a study using endoscopy, 24-hour gastric and esophageal pH metry. Indian J Gastroenterol. 2011 Jan 26.
6. Liu FX, Wang WH, Wang J, Li J, Gao PP. Effect of Helicobacter pylori infection on Barrett’s esophagus and esophageal adenocarcinoma formation in a rat model of chronic gastroesophageal reflux. Helicobacter. 2011 Feb;16(1):66-77.