Innocent bystander or to be eradicated at all costs?

Welcome to Part 3 of the H. pylori series. 

In Part 1 of the H. pylori series, we looked at:

• some context in regards to this unique but misunderstood bacteria in terms of how it is viewed by the medical community and by people seeking to improve their digestive health
• how the medical research community - and some progressive healthcare practitioners - are pushing for a long overdue re-evaluation in regards to the relationship between H. pylori and human health
• numerous amazing facts about this bacteria which really help to set the scene to help us re-evaluate our relationship with it
• the problems caused by inappropriately targeting H. pylori as the culprit in someone's health challenges

In Part 2, we covered:

• typical symptoms that DO or DO NOT warrant H. pylori treatment
• why some people report feeling better after treatment
• common myths about H. pylori such as H. pylori reducing stomach acid in all cases
• the relationship between H. pylori and B12
• virulence factors - what they are and why they matter

In Part 3 below, we will consider:

• The benefits H. pylori confers on our health (really!) particularly for eczema, asthma, GERD and even peptic ulcer disease
• The best testing options for H. pylori

Medical Disclaimer: The information included in this article is for entertainment purposes only. It is not intended or implied to be a substitute for professional medical advice. Reading the information in this article - and the website in general - does not constitute a physician-patient relationship. Discuss any health concerns with your medical provider before starting or changing treatment for any health condition.

Here is where things get really interesting as far as H. pylori is concerned. Given that we are designed to be healthy, given that most people carry H. pylori and given that we co-evolved with microbes that educate our immune system during our early development, doesn't it stand to reason that H. pylori is present in us for a purpose? Pretty cool right? Read on to find out more about the protective role of H. pylori.

Asthma, Dermatitis, Eczema

These conditions all fall into the category of atopic conditions, so they share many etiological similarities. Many individuals will have more than one atopic condition because they are all influenced by the same underlying factors.

In young and middle-aged patients, H. pylori has been found to be inversely correlated with these conditions. This means that as the rate of H. pylori increases in that population, the incidence of these conditions decreases.

Various studies have shown in children that the presence of H. pylori reduces the incidence of asthma. Further, another study has investigated the actual protective mechanism - H. pylori with its various proteins plays an important role in educating the immune system of the host to promote tolerance of various benign antigens that humans encounter all the time. This tolerance plays a role in preventing the hyperreactive immune response that leads to asthma.

Inflammatory Bowel Disease

IBD - Inflammatory Bowel Disease - is an umbrella term covering conditions such as Ulcerative Colitis and Crohn's disease. 

Multiple meta-analyses - statistically powerful overviews of pooled research on a specific topic - show that the risk of IBD is higher in H. pylori-negative individuals. Additionally, there is research showing the eradication of H. pylori has led to the development of intestinal lesions in some individuals.

GERD and its potential complications

This excerpt from a research paper examining the relationship between H. pylori and GERD explains the current state of the research very well:

Helicobacter pylori (H. pylori), as a gram-negative bacterium, plays an important role in the pathogenesis of different GI diseases including gastric ulcer, gastric mucosal lymphoma and gastric cancer [4]. However, the relationship between H. pylori and GERD is a complex and confusing subject that needs further investigation [5, 6]. There are several invasive and non-invasive diagnostic methods for diagnosing H. pylori infection [7].

Some studies have reported a higher prevalence of H. pylori in patients with GERD, while some have observed an inverse relationship. This relationship is difficult to justify because GERD is a disease that is affected by different risk factors include BMI, smoking, lifestyle habits, host factors and more [1,2,3].

To date, the true relationship of H. pylori to GERD is still unclear [4], and recent studies have shown that more research is needed to clarify this association, with a more focus on confounding factors in GERD and H. pylori [5, 6, 8].

https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07278-6

In their studies, a number of authors prove that there is no significant difference between
H. pylori-positive and H. pylori-negative patients and the development of GERD symptoms. Researchers have come to the conclusion that the detection of H. pylori does not affect either the development of GERD symptoms or the severity of the disease course.

The majority of recent evidence from the USA, Europe, and Asia finds that H. pylori "infection" alone - regardless of virulence factors - protects from the development of issues secondary to GERD such as severe reflux oesophagitis and its complications, such as Barrett's oesophagus and adenocarcinoma. Even more striking and consistent has been the protection reported from GERD-related complications in patients with H. pylori "infection" and the cagA+ virulent factor.

In a study investigating the effect of H. pylori treatment on esophageal health factors, it was found that eradication of H. pylori resulted in reduced esophageal peristalsis, enhanced esophageal acid exposure, and aggravated GERD symptoms, suggesting that H. pylori infection may be a protective factor for GERD.

In a research study involving over 800 patients, the detection rate of H. pylori was 77.1% in asymptomatic patients vs 71.4% in GERD patients. So - H. pylori was found at higher rates in those without any GERD symptoms versus those with symptoms.

Peptic ulcer disease (PUD)

Researchers have concluded that there are many factors involved in the development of peptic ulcer disease (PUD) outside of H. pylori "infection". The specific genotype of H. pylori is also a factor. In recent years there has been a reported increase of cases of PUD with a concurrent decrease in the prevalence of H. pylori "infection". 

Moreover, the review data (Araújo et al) indicate that the detection rate of H. pylori infection in patients diagnosed with PUD does not differ from that of H. pylori in the general population. The authors also noted that in 20%-50% of cases of PUD, they are unable to identify the overarching etiological factor of an ulcerative lesion, that is to say, an idiopathic ulcer (H. pylori negative, non-steroidal anti-inflammatory drug-negative peptic ulcer/NSAIDs). Sidorenko[89] stated that the given facts provide a strong argument that refutes the leading role of H. pylori in the development of gastroduodenal diseases.

There is also evidence suggesting that the most favorable course for ulcers is those that are
H. pylori-associated ulcers compared with other diagnosed types. Kanno et al established that among 382 examinees diagnosed with PUD, the patients with a confirmed diagnosis of
H. pylori-positive ulcer had a statistically significant increase in healing rates.

Rasane et al demonstrated that patients with H. pylori-negative peptic ulcer disease had a more pronounced severe course of the disease and a more negative prognosis than those with H. pylori-associated forms.

Testing options for H. pylori

There are various tests available for detecting H. pylori, however they all have considerations and some are not clinically valid. A biopsy during upper endoscopy is considered the gold standard and is essential in the presence of certain symptoms and/or risk factors. The urea breath test and stool antigen test are also available and are the most commonly used. 

Please know that all of these tests - as with every other pathology test available - have their limitations and can potentially lead to more confusion and inappropriate treatment.

Below is a summary of validated tests:

• Biopsy (histology) - this is the closest to a gold standard, it will determine if H. pylori itself is located within the stomach and if it is associated with an ulcer for example. It is conducted during an esophagogastroduodenoscopy (EGD), a more invasive test that cannot be used for pregnant women, young people and the elderly. This test utilises the rapid urease test (RUT) or CLO test to confirm the presence of H. pylori.
• Urea breath test - tells you if H. pylori is currently in your stomach, but nothing about its activity/disease potential
• Stool Antigen test - tells you if H. pylori is currently in your digestive tract by testing for proteins or enzymes associated with H. pylori. However, it doesn't tell you what the relationship is between H. pylori and your symptoms
• IgG antibody blood test - this will only tell you if you've encountered H. pylori at some point in your lifetime - which is the case for most people, so it's not that useful

Unvalidated tests:

• GI Map* stool DNA test (qPCR) - tells you if the bacteria is in your stool** and measures virulence factors***, however neither of these findings give any indication if H. pylori is pathogenic
• Saliva test - not a standard test at all

*some other labs also offer this - this test can present false negative and false positive results where DNA from dead bacteria is detected (though this may be more relevant where someone has had treatment). There has been some critique of PCR methods for H. pylori detection. 

**H. pylori may also found in food, so a stool test could just indicate that you ate something that had H. pylori in it

***We are still learning about virulence factors, there is no consensus as yet - some of these and some combinations may be protective for some conditions

Next in the series

In Part 4 of the H. pylori series, we will look at the risks of inappropriate treatment. This is the key reason I wrote this article series, because I see many clients whose gut health worsened considerably after H. pylori treatment that was unnecessary. We will also consider what to do if you see a positive result for H. pylori so that you can make an informed decision.

References

References and additional resources are listed in Part 1 of the series.

Do you need help figuring out your digestive health problems?

If you're ready to get answers and make meaningful progress with your gut health so you can get back to doing what you love, find out how to work with me. I am a Clinical Nutritionist and Naturopath based in Sydney, Australia. I work with clients worldwide.

I also offer a stool test interpretation service.