H. PYLORI

-Do You Have A Non Healing Peptic Ulcer?

-The Truth About Mastic Gum Resin

By Royce K. Bailey MD, MPH, FAAC, MAAC

 I was approached in the hall this week, by one of the hospital’s employees asking about her father. He had just been diagnosed with H. Pylori (Helicobacter Pylori) of the stomach and refused to have another round of antibiotics. "Is there anything that he can use that is not prescription?" I was asked. "Yes, there is a very successful over-the-counter treatment of H. Pylori without the danger of using recurrent rounds of antibiotics to eradicate this bug."

How Can H. Pylori Affect Me?

H. Pylori are gram-negative rods that can cause open sores (ulcers) in your stomach and small intestine. H. pylori infection can irritate the lining of the stomach, causing inflammation (gastritis). H. pylori infection is a strong risk factor for certain types of stomach cancer, including adenocarcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. More than 50% of the world’s population have a H. pylori infection, but over 80% of individuals infected with the bacterium are asymptomatic. Yet in others, H. pylori can lead to serious complications. Signs or symptoms that can occur with H. pylori infection (as well as other causes) include: An ache or burning pain in your abdomen, frequent burping, bloating, weight loss, severe or persistent abdominal pain, difficulty swallowing, bloody or black tarry stools, bloody or black vomit or vomit that looks like coffee grounds. 

How does H. Pylori Survive the Stomich Acid?

To colonize the stomach, H. pylori must survive the acidic pH and burrow into the mucus of the stomach’s epithelial cell layer. The bacterium has flagella (mobile tails) and moves through the stomach and drills into the mucoid lining of the stomach or bowel. H. pylori senses the pH gradient within the mucus layer by chemotaxis and swims away from the acidic contents towards the more neutral pH environment of the epithelial cell surface. H. pylori induces inflammation and locally high levels of TNF α and interleukin 6. That’s why high doses of omega-3 (flax seed oil, walnuts, fish oil, etc) helps GI symptoms because it down regulates levels of TNF α and interleukin 6. 

How Can I Get H. Pylori?

H. pylori is passed from person to person through direct contact with saliva or fecal matter. H. pylori can also be spread through untreated water and house flies. You may have the infection for years before you have any symptoms. I believe some people are genetically more likely to get a H. Pylori infection than others. What’s the most common cause of recurrent symptoms after successful treatment? Getting exposed to the bacterium again! 

How Do I Find Out If I Have a H-Pylori Infection?

1) The most common way is by pricking your finger for a blood test. The test strips turn positive or negative in 15 minutes, just like a pregnancy test. 2) During a breath test, you drink a solution that contains radioactive carbon molecules. If you have an H. pylori infection, the radioactive carbon is released when the solution is broken down in your stomach. Your body absorbs the radioactive carbon and expels it when you exhale. You exhale into a bag and your doctor uses a special device to detect the radioactive carbon. 3) A laboratory test called a stool antigen test looks for foreign proteins (antigens) associated with H. pylori infection in your stool. 4) During an endoscopy exam, your doctor threads a long flexible tube equipped with a tiny camera (endoscope) down your throat and esophagus and into your stomach and duodenum. Using this instrument, your doctor can view any irregularities in your upper digestive tract and remove tissue samples (biopsy). These samples are analyzed for H. pylori infection.

 

Doctors Demonized for The Right Diagnosis

H. pylori was first discovered in the stomachs of patients with gastritis & stomach ulcers by Dr Barry J. Marshall and Dr J. Robin Warren of Perth, Western Australia, but veterinarians long knew that a round of antibiotics would cure a animal that was not eating (1920). Medical thinking felt that the stomach acid (equal to car-battery acid) would kill any bacteria in it. When I was in Medical School (1977-1980) the standard treatment for recurrent ulcers was a gastric resection and vagotomy. This removed 3/4 of one’s stomach and cut the nerves to their stomach. Drs. Marshall & Warren "re-wrote" the text-books for what caused gastritis & gastric ulcers and received so much vitriol (bitterly abusive outcry) from doctors and scientists around the world that it is reported they had to go into hiding. They finally received their reward: the 2005 Nobel Prize for Medicine & Physiology.

 

 How to Treat H. Pylori

An increasing number of infected individuals are found to have antibiotic-resistant bacteria. This results in initial treatment failure (clarithromycin and amoxicillin for 14 days) and requires additional rounds of antibiotic therapy or quadruple therapy, which adds Bismuth subsalicylate (Peptobismo four times a day for 14 days-makes your stool black) and proton pump inhibitors-PPI (suppress acids by shutting down "pumps" in acid producing cells-twice a day for 14 days): omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium). For the treatment of clarithromycin (Biaxin) resistant strains of H. pylori doctors use levofloxacin (Levaquin) as part of the therapy. Variations of the therapy include using a different proton pump inhibitor, adding peptobismo (the bismuth suppresses the H. Pylori) or replacing amoxicillin with metronidazole (Flagyl) for people who are allergic to penicillin.

 

 So What Do I Recommend?

I recommend first a two week round of antibiotics, with a PPI twice a day for 14 days and Pepto-Bismol 4 times a day (one tbsp or tablet=one dose) for two weeks. If you do not respond, don’t want antibiotics or the symptoms reoccur, I will substitute the antibiotic portion of the protocol with Mastica capsules two 250 mg twice a day (total at least one gram daily), on an empty stomach, for 14 days and include the other two treatments (PPI and Bismuth). Mastica (mastic gum resin) can be found at any health food store. Mastica works very well and resolves many of my patient’s chest pains (after we have proven the chest pain is non-cardiac). I have some patients that will use this treatment several times a year for relief of their recurring symptoms.

 

 Masgic Gum Resin

Mastica is the resin obtained from the Pistacia lentiscus tree (an evergreen shrub from the pistachio tree family) which is grown on the island of Chios in Greece. It has been used for a variety of gastric ailments in Mediterranean and Mideast countries for at least 3,000 years. Traditionally used as a health food in Greece, a 1998 study reported in the New England Journal of Medicine supports mastica’s part in eliminating H. Pylori. Isn’t God wonderful for creating from nature a treatment for man’s upset stomachs?!

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 References:

Graham DY, et al. Helicobacter pylori. In: Feldman M, et al. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/134273666-3/0/1389/0.html. Accessed April 28, 2009.

Fuccio L, et al. Treatment of Helicobacter pylori infection. BMJ. 2008;337:746.

H. pylori and peptic ulcer. National Institute for Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.htm. Accessed April 29, 2009.

Talley NJ, et al. Gastric cancer consensus conference recommends Helicobacter pylori screening and treatment in asymptomatic persons from high-risk populations to prevent gastric cancer. American Journal of Gastroenterology. 2008;103:510.

1998-2010 Mayo Foundation for Medical Education and Research (MFMER).

Mastic Gum kills H. Pylori, NEJM 1998 Dec 24;339(26):1946.