Helicobacter pylori - John Scott looks at various treatment options.

 

Approximately half the world's population carries the H. pylori bacterium, which inhabits the mucous layer of the stomach lining, is persistent and can be difficult to eradicate.

The infection is usually contracted during infancy - possibly via faeces or saliva - but then lies dormant in most people until the lining of the stomach becomes damaged.

Once damage has occurred, H. pylori can cause progressive inflammation of the stomach and it is almost invariably involved in ulceration both of the stomach and the duodenum. It has also been implicated in some forms of stomach cancer and in heart disease.

NSAIDS
One cause of the damage which can allow H. pylori to become a problem is the consumption of NSAIDs - non-steroidal anti-inflammatory drugs, including aspirin and ibuprofen and the many treatments that contain them, such as remedies for arthritis.
Up to half of all patients taking NSAIDs are likely to develop a gastric problem such as an ulcer. (Int J Clin Pract 2002; 56: 2-5)

Diagnosis
The presence of H.pylori can be confirmed by a blood or breath test or by means of a biopsy.

Antibiotic treatment
The usual treatment for this bacterium consists of a seven to fourteen day course of medication combining two antibiotics with a gastric acid-reducing agent, but this triple therapy is not successful in all cases, often because overuse of antibiotics for other conditions has encouraged H. pylori to develop resistance to these drugs.
In a recent pan-European study of 1,233 children with H. pylori infection, resistance to both metronidazole and clarithromycin was found in a quarter of all cases. Details at: www.patienthealthinternational.com/news/11934.aspx

If the triple therapy fails, bismuth may be added to the other three drugs to create a more effective quadruple therapy, but even this is not 100% successful.

Adding probiotic yogurt
A research team in Taiwan recently set out to establish whether the further addition of probiotic yogurt would produce any additional advantage.
One hundred and thirty-eight patients, in whom the triple therapy had failed, were randomised to either a quadruple therapy-plus-yogurt group or a quadruple therapy-only group. Patients then received one week of drug treatment with or without four weeks of pre-treatment with 400 ml daily of the probiotic yogurt.
The rate of eradication of H. pylori was found to be significantly higher in the therapy-plus-yogurt group than in the therapy-only group. Indeed, treatment was considered to have been successful in 91% of those who had taken the yogurt, compared with only 77% in those who had not. (Am J Clin Nutr 2006; 83: 864-869)

Yogurt only?
As it is clear from this study that yogurt effectively suppresses H. pylori when combined with drugs, one wonders what effect the yogurt would have on the bacterium if taken alone, without the drugs, especially if it were consumed over a longer period of time. One also wonders what effect different types of yogurt, containing different probiotic strains, might have on H. pylori and how effective yogurt might be if combined with other natural remedies such as masticgum and/or Manuka honey. Such possibilities are, however, unlikely to be tested in a clinical trial, yet there is nothing to prevent an individual who has
H. pylori, but who does not wish to, or is not able to take antibiotics, from putting these options to the test on themselves. They could also try one or more of the alternative treatments available, for which there is at least good anecdotal evidence.

Other alternatives

Mastic gum
This is a resin extracted from the Pistacia lentiscus tree.
'Mastika', a proprietary product by Allergy Research Group, is commonly used in combination with Berberine and Grapefruit Seed Formula ('ParaGard' by Nutri Ltd). Both products usually need to be taken for several months and can be obtained from The Nutri Centre www.nutricentre.com / 020 7436 5122. Further advice is also available from the Centre's nutritionists.

'Byelori', an alternative proprietary product by Life Enhancement contains mastic gum, thyme, hyperforin and cinnamon and needs to be used for three to six months to eradicate H. pylori.

Homeopathy
The ideal treatment for each individual is selected from several alternatives, according to the symptoms experienced. To talk to a homeopath and order the recommended remedies, from Ainsworths Homeopathic Pharmacy 020 7935 5330 www.ainsworths.com or, to find a local homeopath click here.

Traditional Chinese Medicine (TCM) has a number of remedies which are claimed to be able to eradicate H. pylori and there are clinical
trials to support some of these, but a qualified TCM practitioner is essential in guiding the patient to an effective and safe treatment.
To find a practitioner, contact The Register of Chinese Herbal Medicine 01603 623994 www.rchm.co.uk

Manuka honey
Manuka honey has strong anti-bacterial properties, but only a good quality product should be used.
Take 20ml four times a day for eight weeks. For further details see: 'Susceptibility of Helicobacter pylori to the Antibacterial Activity of Manuka Honey' (J. Royal Soc. Med; 87: 9-12)

Back to antibiotics
For those who are able to take anti- biotics, the most promising approach currently is a new triple drug treatment based on the antibiotic Levofloxacin, which is commonly prescribed to treat such infections as pneumonia and bronchitis.
A recent meta-analysis of therapies, published in the April 2006 issue of The American Journal of Gastroenterology, found this to be
better tolerated and more effective than the bismuth-based quadruple therapy referred to above.

New drugs?
A recent discovery by a researcher at the University of Virginia, USA, may eventually lead to the development of much more effective drug treatments for H. pylori.

The bacterium's survival in the harsh environment of the stomach has been found to depend on sensors which measure the acid level in its immediate environment and allow it to choose a less acidic region of the stomach lining. A drug that specifically targets this acid receptor wouldeffectively reduce the bacterium's ability to survive in the stomach.
(Journal of Bacteriology 2006; 188: 2656-2665) or click here.

 

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First Published in 2006 2006

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