What Is H. Pylori?

Helicobacter pylori is a spiral-shaped bacterium that colonises the stomach lining. It is one of the most successful human pathogens in history: approximately 50% of the global population is infected, making it the most common chronic bacterial infection worldwide. In developing countries, prevalence can exceed 80%.

H. pylori has evolved a remarkable survival mechanism: it produces urease, an enzyme that converts urea to ammonia, creating a local alkaline buffer that protects it from stomach acid. It then burrows beneath the protective mucus layer and adheres to gastric epithelial cells, where it can persist for decades if untreated.

Symptoms of H. Pylori Infection

Most H. pylori-infected individuals are asymptomatic. However, when symptoms develop, they typically include:

  • Burning or gnawing epigastric pain — upper abdominal pain that may be worse on an empty stomach and temporarily relieved by eating
  • Nausea — particularly in the morning or between meals
  • Bloating and early satiety — feeling full after eating small amounts
  • Loss of appetite and unintentional weight loss
  • Acid reflux and belching
  • Dark or tarry stools — indicating upper GI bleeding (this is a red flag requiring urgent medical evaluation)
H. pylori is the primary cause of peptic ulcers (stomach and duodenal ulcers) and is classified as a Group 1 carcinogen by the WHO due to its association with gastric cancer. All symptomatic infections and most asymptomatic infections should be treated.

Less Obvious Connections

H. pylori's effects extend well beyond the stomach:

  • Iron deficiency anaemia — H. pylori impairs iron absorption by reducing stomach acid and directly competing for iron
  • B12 deficiency — reduced acid production impairs B12 liberation from food proteins
  • Rosacea — H. pylori infection is significantly more prevalent in rosacea patients; eradication often improves skin symptoms
  • Migraine — observational studies link H. pylori infection with increased migraine frequency
  • SIBO — by reducing stomach acid, H. pylori removes a key defence against bacterial overgrowth in the small intestine

Testing for H. Pylori

Several reliable tests are available:

  • Urea breath test — the most accurate non-invasive test; you ingest a urea solution and breath samples detect labelled CO2 produced by H. pylori's urease activity
  • Stool antigen test — detects H. pylori proteins in stool; highly accurate and convenient
  • Endoscopy with biopsy — the gold standard; allows direct visualisation and histological examination; also enables antibiotic sensitivity testing
  • Serology (blood antibody test) — can detect exposure but cannot distinguish active from past infection; less useful for confirming eradication

Important: stop PPIs (proton pump inhibitors) 2 weeks before testing and antibiotics 4 weeks before testing, as these can cause false-negative results.

Conventional Treatment

Standard H. pylori eradication involves "triple therapy" or "quadruple therapy":

  • Triple therapy: a PPI + two antibiotics (typically clarithromycin + amoxicillin or metronidazole) for 14 days
  • Quadruple therapy: a PPI + bismuth subsalicylate + two antibiotics for 14 days

Eradication rates have been declining globally due to antibiotic resistance, particularly to clarithromycin and metronidazole. This has increased interest in complementary strategies that may improve eradication rates.

Natural and Complementary Approaches

The following strategies have evidence for supporting H. pylori eradication when used alongside conventional treatment:

Saccharomyces boulardii

Multiple meta-analyses confirm that S. boulardii taken alongside triple therapy improves eradication rates by 10-15% while reducing antibiotic-associated side effects. It is the most evidence-backed adjunctive strategy.

Mastic Gum

Mastic gum, a resin from the Pistacia lentiscus tree, has demonstrated in vitro bactericidal activity against H. pylori, including antibiotic-resistant strains. Clinical studies show modest benefit as an adjunct, with typical dosing of 350mg three times daily.

Sulforaphane (Broccoli Sprouts)

Sulforaphane, concentrated in broccoli sprouts, has shown anti-H. pylori activity in both laboratory and clinical studies. A Japanese RCT found that eating 70g of broccoli sprouts daily for 8 weeks reduced H. pylori colonisation markers significantly.

Manuka Honey

Manuka honey has demonstrated in vitro antibacterial activity against H. pylori. While clinical evidence is limited, its general antimicrobial properties and safety profile make it a reasonable dietary addition during treatment.

Lactoferrin

Bovine lactoferrin supplementation has been shown in several RCTs to improve H. pylori eradication rates when added to standard triple therapy. It works by binding iron that H. pylori needs for survival and by directly damaging bacterial cell membranes.

After Eradication: Rebuilding Gut Health

H. pylori treatment involves potent antibiotics that disrupt the broader gut microbiome. Post-eradication, focus on:

  • Probiotic supplementation for 4-8 weeks (S. boulardii, L. rhamnosus GG)
  • Diverse prebiotic fibre to rebuild microbial diversity
  • Zinc carnosine supplementation to support gastric mucosal healing
  • Confirm eradication with a urea breath test or stool antigen test at least 4 weeks after completing treatment

GutIQ's assessment includes parameters relevant to upper GI health and can help identify symptom patterns consistent with H. pylori infection, prompting appropriate testing and treatment.