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Jan 28, 2008

Safer Treatment for H. Pylori

In 2005, doctors Barry J. Marshall, MD, and J. Robin Warren, MD, won the Nobel Prize in Medicine for their discovery that the incidence of gastritis or stomach inflammation, and in fact stomach ulcers, can be caused by a bacterial infection, Helicobacter pylori [H. pylori]. One might wonder how soothing a sour stomach becomes worthy of a Nobel Prize... but the truth is, this discovery by Drs. Marshall and Warren resulted in a significant change in the course of treatment for millions of people each year. Even more crucial, their research also led to an understanding that, left untreated, H. pylori becomes a risk factor for stomach cancer. Approximately two-thirds of the world's population is infected with H. pylori and sales of drugs that treat it are at an all-time high. Digestive expert Andrew L. Rubman, ND, had some important insights on how to tell if you have H. pylori and how to overcome it in a healthful way if you do.
H. pylori appears to spread person to person, either through contact with feces or saliva, though this process is not fully understood. Once detected, H. pylori is simple enough to treat. Getting a definitive yes or no as to its presence is not always straightforward though, since if you have H. pylori, it doesn't automatically mean you will suffer. In fact, many people are completely unaware that they are infected until they're in real trouble, such as with an ulcer or stomach cancer. Factors that may make a person more susceptible to the ill effects of H. pylori, and consequent ulcers or gastritis, are weakened immunity in the intestine and destructive lifestyle habits such as smoking or chronic stress, though H. pylori can hit anyone.
Symptoms of H. pylori's presence in your digestive tract include any of these listed below if they occur with regularity...
Abdominal burning and pain.
Ongoing indigestion or heartburn.
Nausea and vomiting.
Abdominal bloating and fullness.
Unexplained weight loss.
Difficulty swallowing, especially the sensation that food is "stuck" in your throat.
Gastrointestinal bleeding.
If these symptoms affect you, schedule a visit with your doctor and ask specifically to be tested for H. pylori and associated antibody titers, advises Dr. Rubman. It's a simple blood test and Dr. Rubman believes it is an improvement over upper endoscopy, passing a thin tube with a tiny camera down the throat and into the stomach, which not all that long ago was considered essential to diagnosis. If particular antibodies are present beyond a certain threshold, Dr. Rubman says you can conclude that H. pylori bacteria either is or was active in the lower stomach and is the likely culprit to blame for many of your GI symptoms.
Dr. Rubman voices concern about the fact that many mainstream practitioners continue to rely on endoscopy for diagnosis. He believes that is rarely necessary nowadays, since the blood test is so reliable. Also, there are inherent risks with all invasive procedures, in this case, perforation of the esophagus, stomach or part of the small intestine. Please consult with your gastroenterologist about whether endoscopy is really required for your particular case.
Once the presence of an active H. pylori infection has been established, it needs to be treated and eradicated. According to Dr. Rubman, a common conventional medical approach consists of a triple drug therapy:
Antibiotics, such as clarithromycin or amoxicillin.
Antimicrobial medication such as metronidazole [Flagyl].
Acid-suppressing drugs such as proton pump inhibitors [PPIs]. For example, omeprazole [Prilosec], lansoprazole [Prevacid] or esomeprazole [Nexium] to drastically limit stomach acid production and allow the inflamed tissue to heal.
A recent tweak to this approach, using a different antibiotic/PPI combination before the triple therapy, has shown promise.
But, while Dr. Rubman agrees that treatment with antibiotics and antimicrobials is in order, he's highly critical of using PPIs for chronic gastritis, whether caused by H. pylori or not. He believes these drugs should never be used for periods longer than two weeks, even for acute ulcers. Long-term use of PPIs can lead to assorted health risks including increased risk of hip fracture due to malabsorption of calcium... reduced absorption and usage of nutrients in foods the body relies on... and increased risk of pneumonia and other illness due to the resulting insufficiency of stomach acid that is required to kill the naturally occurring germs on the surface of the foods we eat. In addition, he notes there is a possibility of permanent impairment to gastric acid mechanisms in some individuals. [For more on the dangers of acid suppressing medications, see Daily Health News, April 11, 2006.]
Taking acid-suppressing drugs such as Nexium and Prilosec can make gastritis worse, as reduced levels of acid allow germs to thrive in the digestive tract. The immune system then fights back with an inflammatory response, causing damage to stomach cells that actually contributes to gastritis and other GI diseases. People can end up in a vicious cycle of treatment that leads, endlessly, to the need for more treatment.
Instead of acid suppressants, Dr. Rubman treats his H. pylori patients with a naturopathic remedy containing a bismuth salt akin to the active ingredient in over-the-counter Pepto-Bismol. This soothes the stomach and allows the antibiotics to work more effectively. Dr. Rubman says he finds this individually formulated medication more effective at soothing the stomach symptoms associated with H. pylori than familiar OTC antacid brands. He also advises his patients to continue with the naturopathic bismuth remedy even after the antibiotic and antimicrobial therapies have ended, until symptoms have cleared completely.
While H. pylori infection is very treatable, Dr. Rubman emphasizes that infection can lead to GI problems including gastric cancer, and therefore is not a "do-it-yourself" medical problem. Be sure to see a trained and qualified practitioner for appropriate care. If you would like to consult an ND, since NDs are specially trained in treating digestive challenges, you can find one in your area at the Web site of the American Association of Naturopathic Physicians [].
Andrew L. Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.
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Posted: Monday January 28, 2008, 9:40 am
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