H. Pylori Integrative Care

September 11, 2013 Written by JP       [Font too small?]

If you walk into your doctor’s office with symptoms including abdominal pain, bloating, frequent burping and heartburn you will likely be evaluated for a potential H. pylori infection. This common bacterium can, but does not always, cause unpleasant symptoms. However, if symptoms do arise, it’s important to address the infection in order to protect against chronic stomach inflammation, ulcers , increased risk of stomach cancer and beyond. The most common treatment for Helicobacter pylori is a combination of three medications – two antibiotics and an acid suppressing drug.

The combination or “triple therapy” described above is the current standard of care. Unfortunately, the addition of certain complementary, natural treatments is not yet widely accepted. But, that doesn’t mean that you can’t inform yourself about an integrative approach to H. pylori care. And, once you do, you can share the information you’ve learned with your doctor in order to improve the quality of your care.

If I were diagnosed with an H. pylori infection I would incorporate three, evidence-based natural approaches. For starters, I would eat a few servings of probiotic yogurt every day for 4 weeks prior to treatment and for several weeks following successful eradication. The addition of kefir and other cultured foods may also be of benefit. Vitamin C, at a dosage of 500 mg, twice-daily, is another alternative therapy I would employ. And finally, Saccharomyces boulardii is a probiotic yeast that has been extensively studied in patients with H. pylori. These foods and supplements have all been shown to improve treatment outcomes and reduce drug-related side effects – diarrhea, nausea, yeast infections, etc. What’s more they are inexpensive and safe.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Randomized Control Trial: Comparison of Triple Therapy Plus Probiotic (link)

Study 2 - Probiotic-Containing Yogurts Suppress Helicobacter Pylori Load and (link)

Study 3 - Pretreatment w/ Lactobacillus- and Bifidobacterium-Containing Yogurt(link)

Study 4 – Kefir Improves the Efficacy and Tolerability of Triple Therapy in … (link)

Study 5 - The Efficacy of H. Pylori Eradication regimen with & without Vitamin C … (link)

Study 6 - Adjuvant Effect of Vitamin C on Omeprazole-Amoxicillin-Clarithromycin (link)

Study 7 – Supplementing Vits C & E to Standard Triple Therapy for the Eradication (link)

Study 8 - Meta-Analysis: The Effects of Saccharomyces Boulardii Supplementation (link)

Study 9 - A Randomized, Open Trial Evaluating the Effect of S. Boulardii on the … (link)

Study 10 - Efficacy & Safety of S. Boulardii in 14-Day Triple Anti-Helicobacter (link)

Probiotic Yogurt Improves Efficacy of H. Pylori Antibiotic Treatment

Source: Am J Clin Nutr. 2006 Apr;83(4):864-9. (link)

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6 Comments & Updates to “H. Pylori Integrative Care”

  1. JP Says:

    Update 05/13/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166824/

    Pharmacognosy Res. 2014 Oct;6(4):341-4.

    Effect of licorice versus bismuth on eradication of Helicobacter pylori in patients with peptic ulcer disease.

    BACKGROUND: Different therapeutic regimens were used for eradication of Helicobacter pylori, based on the cost, effectiveness and patient’s compliance. The aim of this study was the evaluation of licorice compared with bismuth in quadruple regimen on eradication of H. pylori in patients with peptic ulcer disease (PUD).

    MATERIALS AND METHODS: In a double-blind clinical trial study, 60 patients with PUD and positive rapid urease test were enrolled. The patients were randomly allocated into two equal groups. In first group, licorice, amoxicillin, metronidazole and omeprazole and in the second (control) group, bismuth subsalicylate, amoxicillin, metronidazole and omeprazole were prescribed respectively, and 4 weeks after treatment, in order to evaluate H. pylori eradication, urea breath test was done in all patients. The outcome of the study was the preference usage of licorice as an effective medication for H. pylori eradication.

    RESULTS: Mean age of the patients in the control and case groups were 40.8 ± 15.5 and 42.2 ± 15.8 years, respectively (P = 0.726). Seventeen (56.7%) patients in control group and 16 (53.3%) in the case group were female (P = 0.795). Both groups were similar based on frequency of gastric or duodenal ulcer. Response to treatment were seen in 20 (67%) and 17 (57%) patients of case and control groups, respectively (P > 0.05).

    CONCLUSION: Our study showed that licorice is as effective as bismuth in H. pylori eradication; therefore, in patients whom bismuth is contraindicated, licorice can be used safely instead.

    Be well!

    JP

  2. JP Says:

    Update 05/13/15:

    http://journals.lww.com/md-journal/Fulltext/2015/05010/Probiotics_for_Standard_Triple_Helicobacter_pylori.5.aspx

    Medicine (Baltimore). 2015 May;94(17):e685.

    Probiotics for Standard Triple Helicobacter pylori Eradication: A Randomized, Double-blind, Placebo-controlled Trial.

    The primary objective in the study is determination of efficacy of probiotic preparation as a supportive therapy in eradication of Helicobacter pylori.The study was multicenter, prospective, randomized, placebo controlled, and double-blind. The subjects first filled out a specially designed questionnaire to assess the severity of the 10 symptoms, which can be related to eradication therapy to be monitored during the trial. Each subject then received 28 capsules of probiotic preparation or matching placebo capsules, which they were supposed to take over the following 14 days, twice a day, at least 2 hours prior to or after the antibiotic therapy administration.A total of 804 patients were enrolled in the trial, of which 650 (80.85%) were included in the analysis. The results show a significantly larger share of cured subjects in the probiotic arm versus the placebo arm (87.38% vs 72.55%; P < 0.001). Additionally, presence and intensity of epigastric pain, bloating, flatulence, taste disturbance, loss of appetite, nausea, vomiting, heartburn, rash, and diarrhea were monitored over the study period. At 15 days postinclusion, probiotic treatment was found superior to placebo in 7 of 10 mentioned symptoms. Average intensity for symptoms potentially related to antibiotic therapy was significantly higher in the placebo group, 0.76 vs 0.55 (P < 0.001).Adding probiotics to the standard triple therapy for H pylori eradication significantly contributes to treatment efficacy and distinctly decreases the adverse effects of therapy and the symptoms of the underlying disease.

    Be well!

    JP

  3. JP Says:

    Update 05/13/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391996/

    Pediatr Gastroenterol Hepatol Nutr. 2015 Mar;18(1):17-22.

    The Efficacy of Saccharomyces boulardii CNCM I-745 in Addition to Standard Helicobacter pylori Eradication Treatment in Children.

    PURPOSE: This study aims to investigate Saccharomyces boulardii CNCM I-745 during Helicobacter pylori eradication in children.

    METHODS: One hundred ninety-four H. pylori positive children were randomized in two groups. Therapy (omeprazole+clarithromycin+amoxicillin or omeprazole+clarithromycin+metronidazole in case of penicillin allergy) was given to both groups during two weeks. In the treatment group (n: 102) S. boulardii was added to the triple therapy, while the control group (n: 92) only received triple therapy. The incidence, onset, duration and severity of diarrhea and compliance to the eradication treatment were compared. A (13)C urea breath test was done 4 weeks after the end of eradication therapy in two groups of 21 patients aged 12 years and older to test the H. pylori eradication rate.

    RESULTS: In the treatment group, diarrhea occurred in 12 cases (11.76%), starting after 6.25±1.24 days, lasting 3.17±1.08 days, and compliance to eradication treatment was 100%. In the control group, diarrhea occurred in 26 cases (28.26%), starting after 4.05±1.11 days, lasting 4.02±0.87 days, and in six cases eradication treatment was stopped prematurely (p<0.05). The (13)C urea breath test showed successful H. pylori eradication in 71.4% of the patients in the treatment and in 61.9 % in the control group (not significant).

    CONCLUSION: S. boulardii has a beneficial effect on the prevention and treatment of diarrhea during H. pylori eradication in children. Although S. boulardii did only slightly increase H. pylori eradication rate, compliance to eradication treatment was improved.

    Be well!

    JP

  4. JP Says:

    Update 07/13/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482816/

    World J Methodol. 2015 Jun 26;5(2):101-7.

    Current Helicobacter pylori treatment in 2014.

    Helicobacter pylori is one of the most commonly seen bacterium worldwide. It’s in the etiology of multiple gastrointestinal diseases, ranging from gastritis to gastric carcinoma. The antimicrobial therapies, which are frequently prescribed empirically, are losing their effectivity as a result of the increasing antimicrobial resistance. As the standard triple therapy is now left especially in areas with high-clarithromycin resistance due to decreased eradication rates, quadruple therapies are recommended in most regions of the world. Alternatively, concomitant, sequential and hybrid therapies are used. There is still a debate going on about the use of levofloxacin-based therapy in order to prevent the increase in quinolone resistance. If no regimen can achieve the desired eradication rate, culture-guided individualized therapies are highly recommended. Probiotics, statins and n-acetylcysteine are helpful as adjuvant therapies in order to increase the effectiveness of the eradication therapy. Herein, we focused on different eradication regimens in order to highlight the current Helicobacter pylori treatment.

    Be well!

    JP

  5. JP Says:

    Update 07/13/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483842/

    Int J Clin Exp Med. 2015 Apr 15;8(4):6530-43.

    Probiotics improve efficacy and tolerability of triple therapy to eradicate Helicobacter pylori: a meta-analysis of randomized controlled trials.

    OBJECTIVE: Gastric colonization by Helicobacter pylori is linked to a host of diseases, but eradication rates have declined in recent years. Some experimental studies suggest that probiotics may inhibit growth of H. pylori. This investigation was conducted to assess the impact of probiotics on both efficacy and tolerability of triple therapy to eradicate H. pylori.

    METHODS: PubMed, Web of Science, and the Cochrane Collaboration were searched for relevant articles published through August 31, 2014. All analytics relied on commercially available software (Stata 11).

    RESULTS: Twenty-three studies (N = 3900) qualified for meta-analysis. Pooled H. pylori eradication rates for triple therapy used alone and with added probiotics were 1464/2026 (72.26%; 95% CI, 67.66%-74.13) and 1513/1874 (80.74%; 95% CI, 74.68%-82.76%), respectively (odds ratio [OR] = 0.58; 95% CI, 0.50-0.68). Loss of appetite was similar in both groups (OR = 0.94; 95% CI, 0.61-1.45), but most adverse events (nausea, diarrhea, epigastric pain, vomiting, taste distortion, and skin rash) were mitigated through addition of probiotics. Publication bias was not evident, as indicated by Begg’s and Egger’s tests.

    CONCLUSIONS: Probiotics may improve the efficacy of triple therapy in eradicating gastric H. pylori and alleviate most treatment-related adverse events.

    Be well!

    JP

  6. JP Says:

    Updated 11/1/16:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052411/

    Avicenna J Phytomed. 2016 Sep-Oct;6(5):495-501.

    Assessment of antibacterial effect of garlic in patients infected with Helicobacter pylori using urease breath test.

    OBJECTIVE: Helicobacter pylori (H. pylori) is the most common pathogenic bacteria in the stomach. The aim of the current study was to explore the effect of oral garlic administration on bacterial urease activity inside the stomach and its contribution to the treatment of H. pylori infection.

    MATERIALS AND METHODS: In this clinical trial, 15 patients were studied quantitatively with Urease Breath Test (UBT). The patients with gastrointestinal symptoms and a positive serum H. pylori IgG were enrolled. UBT was performed for each patient in three sessions as follows: at the beginning of the study, an initial UBT was performed based on which, the positive cases entered the study and the negative ones were excluded. Second UBT was done three days later in patients who were not receiving any treatment and were considered as the control, whereas the third UBT was performed three days after prescribing two medium-sized cloves of garlic (3 g) with their meal, twice a day (at noon and in the evening). The collected data were analyzed using ANOVA and Bonferroni tests and the significance level was set at p<0.05.

    RESULTS: The mean UBT significantly differed before and after treatment with garlic cloves, being significantly lower after garlic consumption. No meaningful difference was observed in the mean UBT without garlic consumption between the first and second steps.

    CONCLUSION: Raw garlic has anti-bacterial effects against H. pylori residing in the stomach and may be prescribed along with routine drugs for the treatment of gastric H. pylori infection.

    Be well!

    JP

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