Does Garlic Kill Good Bacteria?
Compared with Western food for one person, the Chinese people who form a table for dinner are closer.
However, behind this lively joy, there are also some health risks:
For example, many people have heard of: Helicobacter pylori.
1. Half of the Chinese people are infected with Helicobacter pylori
According to conservative estimates from the World Gastrointestinal Organization (WGO), at least half of the world’s population is infected with Helicobacter pylori.
And China is a "helicobacter pylori infection country", the infection rate is as high as 59%, and nearly 700 million people have been infected. Simply put, 3 out of every 5 people have been infected with this virus.
When the human body is infected with Helicobacter pylori, most patients have no symptoms.
There are also some patients with symptoms similar to indigestion, such as bloating, nausea, and belching. Peptic ulcers and dyspepsia may also occur. When peptic ulcers occur, patients may experience severe abdominal pain, and may even have hematemesis and black stools.
Can eating garlic kill Helicobacter pylori? No symptoms without treatment? The truth is here
2. Can eating garlic kill Helicobacter pylori?
As more and more people are infected with Helicobacter pylori, rumors on the Internet also increase.
Many people say that garlic contains a kind of allicin, which has anti-bacterial and anti-inflammatory effects. Eating garlic regularly can help eliminate Helicobacter pylori.
But the truth is not so!
Deputy Director Yu Changhui, Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, told us: "Although garlic has a certain bactericidal effect, its effect is actually very weak. Its allicin content is not high, and it has not reached It is possible to kill Helicobacter pylori. After all, it is only a food material and not a traditional Chinese medicine. The treatment of Helicobacter pylori is actually a psychological comfort, and it cannot play a substantial role in eliminating it."
Taking two antibacterial drugs at the same time will not necessarily kill the bacteria, let alone just a "allicin"?
Furthermore, garlic has a strong stimulating effect. Patients with Helicobacter pylori infection have a weaker stomach. After stomach stimulation, they may feel more uncomfortable.
For example, patients with Helicobacter pylori may be accompanied by peptic ulcer, and patients with peptic ulcer should try to eat less irritating food. If you eat garlic, it may make your stomachache more obvious.
So, this is a very unreliable prescription.
Can eating garlic kill Helicobacter pylori? No symptoms without treatment? The truth is here
Third, infection with Helicobacter pylori, should I treat it?
The current study found that out of every 100 patients infected with Helicobacter pylori, about 30 patients have uncomfortable feelings, such as bloating, stomach pain, acid reflux, heartburn, etc. The remaining 70 patients have basically no symptoms.
Asymptomatic patients, the most concerned question is: Is it possible not to treat?
Everyone should know that does not feel any discomfort symptoms, it does not mean there is no problem! The reverse is also true. People who really suffer from certain diseases have no symptoms in the early stage. Just like a popular saying among gastroenterologists, "The typical symptoms of early gastric cancer are no symptoms."
Helicobacter pylori belongs to category 1 carcinogen, although infection with Helicobacter pylori does not necessarily lead to gastric cancer. However, after being infected with Helicobacter pylori, not paying attention to it will cause gastritis and risk of cancer.
A number of randomized controlled studies conducted in China with a high incidence of gastric cancer and Japan over the years have found that the eradication of Helicobacter pylori by can significantly reduce the risk of subsequent gastric cancer!
Dr. Dai Shixue, Department of Gastroenterology, Guangdong Provincial People’s Hospital, told us that the diagnosis of Helicobacter pylori is mainly confirmed by carbon 13 or carbon 14 breath test, which is confirmed as Helicobacter pylori by breath test.For patients with bacterial infections, it is recommended to have anti- Helicobacter pylori treatment. The course of treatment is two weeks, and the international standard quadruple plan is adopted.
Can eating garlic kill Helicobacter pylori? No symptoms without treatment? The truth is here
Fourth, to prevent Helicobacter pylori, starting from the split meal
Hp is mainly infected through the oral-oral, fecal-oral, appetite-oral pathways, that is to say The digestive tract is the main route of infection.
Therefore, it is recommended to change the way of dining daily, adopt a meal sharing system, and disinfect tableware such as dishes and chopsticks regularly to reduce the rate of bacterial infection. Infants and young children should avoid mouth-to-mouth feeding.
In addition, you must pay attention to personal hygiene, especially hand hygiene, and wash your hands after going to the toilet and before eating.
I need to remind everyone that although Helicobacter pylori is not easy to recur after eradication, if you do not pay attention to hygiene, you may still be infected again. Therefore, it is very important to develop good hygiene habits!
In 2018 almost half of the estimated deaths from gastric cancer—the third leading cause of deaths from cancer globally—occurred in China.1 Linqu County, a rural area in Shandong province, northeastern China, has one of the highest mortality rates from gastric cancer worldwide (age adjusted rates per 100 000 were 55 for men and 19 for women in 1980-82).2 Solid evidence from epidemiologic studies links infection with Helicobacter pylori to the progression of precancerous gastric lesions and development of gastric cancer, and shows that diets rich in vitamin and garlic could protect against gastric cancer in high risk people with insufficient vitamin intake.345 In 1995, the Shandong Intervention Trial was initiated in Linqu to evaluate the effects of three interventions in preventing the progression of precancerous gastric lesions to gastric cancer.6789 The interventions included H pylori treatment for two weeks and vitamin and garlic supplementation for just over seven years. After almost 15 years of follow-up (1995-2010), the trial reported a statistically significant reduction in incidence of gastric cancer and a non-statistically significant reduction in deaths due to gastric cancer associated with H pylori treatment, and the trial was recognized as the first to show a clear reduction in gastric cancer incidence with H pylori treatment.81011 Both garlic and vitamin supplementation showed favorable trends for decreased gastric cancer incidence and mortality, but these effects were not statistically significant.8
The Strongest Natural Home Remedy for H. Pylori
Although the Shandong Intervention Trial suggested a potential role of H pylori treatment in the prevention of gastric cancer, further follow-up was needed to determine whether the reductions would persist and lead to a noticeable decrease in gastric cancer mortality. It also remained unknown whether vitamin and garlic supplementation would be associated with statistically significant reductions in gastric cancer incidence and mortality in the longer term. We therefore extended the follow-up to just over 22 years after randomization to ascertain gastric cancer incidence and mortality. Secondary outcomes were associations with other cause specific deaths.
Methods
Study population
In 1995 the Shandong Intervention Trial, a blinded randomized factorial placebo controlled trial, was initiated in Linqu, China.678 The year before the trial, a census of 13 randomly selected villages within four townships in Linqu identified 4010 residents aged 35-64 years. Of 3599 people who agreed to undergo gastroscopy with biopsies and to provide blood for H pylori serology, 3411 were randomly assigned to the trial in 1995678 (see supplementary table 1). After exclusions for not meeting the eligibility criteria, 3365 people were included in the trial. A total of 2258 participants who were seropositive for antibodies to H pylori, as determined by IgG serology from enzyme linked immunoassay in 1994, were randomly assigned to three interventions (H pylori treatment with amoxicillin and omeprazole for two weeks, and/or garlic supplementation for 7.3 years, and/or vitamin supplementation for 7.3 years) or their placebos in a 2×2×2 factorial design. Overall, 1107 participants who were H pylori negative were randomly assigned to garlic supplementation and/or vitamin supplementation or their placebos in a 2×2 factorial design. The research service provider Westat (Rockville, MD) generated the randomized treatment assignments, and the participants received pill bottles bearing assignment codes to mask both participants and investigators to treatment.
From 15 September to 29 November 1995, H pylori positive participants received one capsule of 1 g amoxicillin and 20 mg omeprazole (n=1130) or a look alike placebo capsule (n=1128) twice daily for two weeks for H pylori treatment. To maintain masking, H pylori negative participants received a placebo capsule twice daily during the same period. 13C urea breath tests from January to March 1996 detected 382 participants who were still H pylori positive after initial treatment and they received treatment for a further two weeks. To preserve masking, 383 participants in the placebo group matched on village, age, and sex received repeat placebo treatment. For vitamin supplementation (30 November 1995 to 31 March 2003), participants received one capsule of 250 mg vitamin C, 100 IU vitamin E, and 37.5 μg selenium (n=1677) or a look alike placebo capsule (n=1688) twice daily for 7.3 years. From December 1995 to May 1996, the vitamin supplement also contained 7.5 mg β carotene.6 During this period, participants assigned to garlic supplementation received two capsules each containing 200 mg aged garlic extract and 1 mg steam distilled garlic oil (n=1678), or two look alike placebo capsules (n=1687), twice daily. Minute quantities of garlic oil were added to the placebo bottles to mask assignment.
Follow-up and assessment of study endpoints
We followed participants from date of randomization (23 July 1995). Participants were visited daily for pill countingduring H pylori treatment and participants were visited monthly to distribute supplements and count pills during the period of vitamin and garlic supplementation. In addition, we measured serum levels of vitamin E, vitamin C, and S-allylcysteine in randomly selected participants to monitor use of vitamin and garlic supplementation. Data from pill counts and sampled blood assays showed excellent treatment compliance. The initial follow-up ended on 1 May 2003 and the extended follow-up ended on 1 December 2017.
The primary outcomes were gastric cancer incidence and mortality. We also assessed cause specific cancer and cardiovascular disease mortality as secondary outcomes. Incidence of gastric cancer was ascertained from scheduled gastroscopies in 1999 and 2003 for all participants, with biopsy samples taken from seven standard sites; scheduled gastroscopies in 2007 for those with a diagnosis of intestinal metaplasia or dysplasia at any biopsy site in 2003; repeat gastroscopies every six months to one year between 2008 and 2017 for those with a diagnosis of moderate or severe dysplasia at any biopsy site or with mild dysplasia at two or more sites in 2003; or cancer registry or autopsy reports, which were confirmed through medical records. Details of gastroscopy and biopsy procedures and histopathologic criteria are described elsewhere.212 We obtained causes of death from the reporting system managed by the Chinese Center for Disease Control and Prevention, which integrates death certificates from hospitals and police and judicial departments in Linqu. To avoid missed records from delayed reporting, a local doctor supervised the follow-up in each village and documented the vital status and occurrence of cancer and major chronic diseases. Staff from Peking University Cancer Hospital visited the villages every three months after 2003 to gather information on gastric cancer incidence and cause specific mortality.
Statistical analysis
In the primary analyses, we examined the risk of gastric cancer incidence and mortality associated with the three interventions. Because gastric cancer was diagnosed in many participants at scheduled gastroscopies in 1999 and 2003, we estimated odds ratios for cumulative incidence of gastric cancer and corresponding 95% confidence intervals. We used conditional logistic regression stratified on baseline histopathology, categorized as moderate chronic atrophic gastritis or less severe gastric lesions, severe chronic atrophic gastritis or superficial intestinal metaplasia, deep intestinal metaplasia, or dysplasia. We adjusted the analyses for other potential confounders, including age, sex, history of ever using alcohol, and history of ever smoking. Conditional logistic regression is helpful when there are only a few participants per stratum, as it eliminates the nuisance intercept, whereas unconditional logistic regression can yield unreliable inference because of the necessity to estimate many intercepts, one per stratum. Our study contained only a few stratums, but as the numbers in each stratum increase, the conditional logistic analysis becomes asymptotically fully efficient. Conditional logistic regression has the additional advantage of paralleling that of stratified Cox regression.
For analysis of gastric cancer mortality, we used the Cox proportional hazards models on the scale of time since randomization to estimate hazard ratios and 95% confidence intervals, stratified on baseline histopathology. The proportional hazards assumption within stratums was tested by including an interaction term between time and treatment (P>0.05 for all tests). In the multivariate adjusted models, Cox regression analyses were further adjusted for age, sex, smoking, and alcohol intake.
Sensitivity analyses included indicators for the other treatments in addition to the treatment being analyzed in the regression models. In secondary analyses, we used the Cox model to assess associations of interventions with all cause mortality and cause specific mortality, including deaths from any cancer, individual cancers with at least 10 deaths among participants who were H pylori positive at baseline, and cardiovascular disease.
For each intervention we plotted Kaplan-Meier survival curves to compare time to all cause mortality and gastric cancer mortality. We further examined the temporal changes in the effects of interventions on cumulative incidence of gastric cancer and on mortality by dividing follow-up into three periods: the initial trial period (from randomization to 1 May 2003),7 the first extended follow-up period (2 May 2003 to 1 August 2010),89 and the second extended follow-up period (2 August 2010 to 1 December 2017).
We stratified analyses to determine whether the effects of interventions varied by participants’ baseline histopathology or age. The Q statistic for meta-analysis was used to evaluate heterogeneity of odds ratios or hazard ratios across stratums. To clarify potential effect modification between interventions, we also tested the two way interactions between H pylori treatment, vitamin supplementation, and garlic supplementation on gastric cancer incidence and mortality.
Analyses were performed using the intention-to-treat approach. P values were two tailed. Statistical calculations were performed with SAS statistical software, version 9.4 (SAS institute, Cary, NC).
Patient and public involvement
No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for recruitment, design, or implementation of the study. No patients were asked to advise on interpretation or writing of results. Before the trial started, extensive information about gastric cancer was disseminated locally to promote the residents’ participation. Peking University Cancer Hospital has reported and will report the results by publication, presentation at scientific meetings, and public events to promote cancer prevention and control. The results will also be disseminated using social media.
Results
A total of 3365 participants were included in the trial (see supplementary table 2). Block randomized intervention assignments6 ensured balanced distribution in baseline characteristics between treatment and placebo groups for the three interventions. During 22.3 years of follow-up (fig 1), 151 incident cases of gastric cancer and 94 deaths from gastric cancer were identified. Of these, 119 (79%) and 76 (81%), respectively, occurred among participants who were baseline H pylori positive (table 1). Most of the cancers were non-cardia types (see supplementary table 3).
Fig 1
Fig 1
Flow diagram of trial design and participant follow-up
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Table 1 Number of participants with incident gastric cancer and mortality by intervention groups during trial and extended follow-up*
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H pylori treatment was inversely associated with risk of gastric cancer, even after multivariate adjustment (odds ratio 0.48, 95% confidence interval 0.32 to 0.71) (table 2). Incidence decreased significantly with vitamin supplementation but not with garlic supplementation (0.64, 0.46 to 0.91 and 0.81, 0.57 to 1.13, respectively).
Table 2 Odds ratios (95% confidence intervals) for incidence of gastric cancer by Helicobacter pylori treatment, and vitamin and garlic supplementation
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A statistically significant protective effect on gastric cancer mortality was observed for all three interventions: fully adjusted hazard ratio was 0.62 (95% confidence interval 0.39 to 0.99) for H pylori treatment, 0.48 (0.31 to 0.75) for vitamin supplementation, and 0.66 (0.43 to 1.00) for garlic supplementation (table 3). Kaplan-Meier curves showed that the cumulative protective effect on gastric cancer mortality became evident after about eight years for H pylori treatment and vitamin supplementation and after about 12 years for garlic supplementation (fig 2). For both gastric cancer incidence and mortality, sensitivity analyses adjusted for other interventions yielded similar findings (data not shown).
Table 3 Hazard ratios (95% confidence intervals) for cause specific death by Helicobacter pylori treatment, and vitamin and garlic supplementation
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Fig 2
Fig 2
Kaplan-Meier survival estimates for gastric cancer mortality and total mortality by Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation. Follow-up time is from trial randomization
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Separate analyses for the three follow-up periods did not show statistically significant heterogeneity in treatment effects in odds ratios for gastric cancer incidence or hazard ratios for gastric cancer mortality (fig 3), possibly owing to limited power. The effects from garlic supplementation were, however, negligible in the initial trial period for both gastric cancer incidence and gastric cancer mortality, and effects only became apparent by 14.7 years and persisted during the 22.3 years of follow-up. The treatment effect for vitamin supplementation in the initial trial period was also negligible for gastric cancer incidence but not for gastric cancer mortality.
Fig 3
Fig 3
Association of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation with gastric cancer incidence and mortality during three periods (trial period 23 July 1995 to 1 May 2003, first extended follow-up period 2 May 2003 to 1 August 2010, and second extended follow-up period 2 August 2010 to 1 December 2017). Analyses were adjusted for baseline histology (moderate chronic atrophic gastritis or less severe gastric lesions, severe chronic atrophic gastritis or superficial intestinal metaplasia, deep intestinal metaplasia, dysplasia), age, sex, history of ever using alcohol, and history of ever smoking. Whiskers represent 95% confidence intervals
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In secondary analyses (table 3), vitamin supplementation was marginally associated with decreased all cause mortality (hazard ratio 0.87, 0.76 to 1.01, P=0.07). No statistically significant associations were found for all cancer mortality or esophageal cancer specific mortality. H pylori treatment was marginally associated with a decrease in risk of colorectal cancer mortality (P=0.07) and a non-significant increase in liver cancer mortality (P=0.15). The associations with other specific causes of death were also non-significant (table 3).
No statistically significant evidence of heterogeneity was found in the effects of H pylori treatment or garlic supplementation for gastric cancer incidence or mortality among participants with differing baseline histopathology, or among different age groups. Although tests for heterogeneity were only marginally significant for vitamin supplementation, the data suggest a greater preventive effect for those with favorable baseline histology (normal, superficial gastritis, chronic atrophic gastritis) and those younger than 45 years, for both gastric cancer incidence and mortality (fig 4).
Fig 4
Fig 4
Association of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation with gastric cancer incidence and mortality, stratified by baseline gastric lesions and age. Analyses were adjusted for baseline histology (moderate chronic atrophic gastritis or less severe gastric lesions, severe chronic atrophic gastritis or superficial intestinal metaplasia, deep intestinal metaplasia, dysplasia), age, sex, history of ever using alcohol, and history of ever smoking. SG=superficial gastritis; CAG=chronic atrophic gastritis; IM=intestinal metaplasia; DYS=dysplasia
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We tested two way interactions for treatment effects. Among baseline H pylori seronegative participants, a non-significant indication suggested that participants who only took vitamin supplements had a lower incidence of gastric cancer than those who took vitamin or garlic supplements (P for interaction=0.08) (see supplementary table 4). These interaction tests were not adjusted for multiple comparisons, however, and were not nominally statistically significant.
Discussion
In the Shandong Intervention Trial, the preventive effect of short term treatment (two weeks) for Helicobacter pylori infection on risk of gastric cancer continued 22 years post-treatment and was associated with statistically significant fewer deaths due to gastric cancer. We also found a significantly decreased long term risk of gastric cancer associated with vitamin supplementation and a reduced risk of gastric cancer mortality with vitamin or garlic supplementation.
Principal findings and comparison with other studies
Previous intervention trials789131415161718 and recent studies1920 have examined the effect of H pylori treatment on gastric cancer. Although treatment is recognized as a potential strategy for the prevention of gastric cancer,1121 major uncertainties require clarification before the strategy can be implemented at community level. As the development of gastric cancer involves progression through multiple histologic stages, the duration of effectiveness of H pylori treatment needs to be studied by long term follow-up.22 Our findings confirm the statistically significant reduction in gastric cancer incidence and favorable although statistically non-significant reduction in gastric cancer mortality after 14.7 years,8 indicating an even greater beneficial effect of H pylori treatment on incidence of gastric cancer than we previously reported at 14.7 years (odds ratio 0.61, 95% confidence interval 0.38 to 0.96).8 The reduction in gastric cancer incidence in the Shandong Intervention Trial was also larger than in recent meta-analyses of intervention trials.2324 As more gastric cancer deaths occurred during longer follow-up, the reduction in gastric cancer mortality became statistically significant 22.3 years after intervention, although the effect became visible in Kaplan-Meier curves after roughly eight years.
Gaps remain about the full range of beneficial and adverse effects from H pylori treatment. An inverse association of H pylori infection with esophageal adenocarcinoma has been reported.112526 Although uncertainty remains for esophageal squamous cell carcinoma, a meta-analysis found a decreased risk of this cancer associated with H pylori infection in eastern populations.26 The Shandong Intervention Trial provided few events and had little power to detect effects of H pylori treatment on esophageal cancer mortality and cannot distinguish esophageal squamous cell carcinoma from esophageal adenocarcinoma (rare in this region); however, there is little indication of adverse risk. An increased risk of colorectal cancer associated with H pylori infection has also been reported.27 Our study found a reduction in deaths due to colorectal cancer with H pylori treatment, but the number was too small to confirm this effect. In addition, we found a non-significant excess of deaths due to liver cancer with H pylori treatment. Despite prolonged follow-up in our trial, the sample size for H pylori treatment (n=2242) limited our ability to estimate the benefits and risks for many health outcomes.
Whether a point exists in H pylori associated gastric carcinogenesis after which treatment would be too late to reduce the risk of gastric cancer is still debatable, as H pylori infection is linked to early precancerous histopathologic changes.12 The Maastricht V/Florence consensus report stated that H pylori eradication results in a clear improvement of gastritis and gastric atrophy but not of intestinal metaplasia.28 A trial also showed that eradication of H pylori did not reduce the incidence of intestinal metaplasia or decrease its histological severity.29 However, the consensus report also recognized that the progression of intestinal metaplasia can be halted by eradicationof H pylori,28 as supported by our intervention trial.7 Advanced gastric lesions occur more often at old ages,212 which raises concerns about the effectiveness of prophylactic H pylori eradication among those with advanced gastric lesions and older people. Such concerns have been partly addressed by evidence that H pylori treatment reduces the incidence of metachronous gastric cancer,2030 but other reports on new gastric cancer with precancerous lesions or metachronous gastric cancer have been contradictory,1531 and some experts recommend using H pylori treatment only before gastric atrophy or intestinal metaplasia develops.15 Our long term data confirm the earlier finding of the Shandong Intervention Trial9 that H pylori treatment reduces gastric cancer incidence and mortality also in participants with intestinal metaplasia and dysplasia and in those aged 55-71 years at baseline. Thus H pylori infection might promote late stage neoplastic progression. It is also possible that H pylori treatment eliminates non-H pylori bacteria crucial for progression to gastric cancer,932 supporting the need to explore other microbiota underlying gastric carcinogenesis. Regardless, H pylori treatment is potentially useful for old as well as young people and for those with advanced as well as early precancerous gastric lesions.
Few intervention trials have been conducted in populations with nutritional deficiencies. The Linxian Nutrition Intervention Trial showed a durable beneficial effect from supplementation for 5.25 years with a combination of selenium, vitamin E, and beta-carotene (“factor D”) on total and gastric cancer mortality, which lasted up to 10 years post-trial but subsequently waned.333435 In Linqu, where the Shandong Intervention Trial was conducted, the mean serum levels of vitamin C and selenium were well below reference ranges.336 In this nutritionally deprived population, observational studies showed that the risk of gastric cancer was inversely associated with vitamin C intake.5 A high level of serum vitamin C was also associated with a decreased risk of histologic progression to dysplasia and gastric cancer in Linqu.3 Our previous follow-up for 14.7 years revealed noteworthy, but not statistically significant, reductions in gastric cancer incidence and mortality. Thus, the statistically significant reductions in gastric cancer incidence and mortality after 22.3 years are supported by earlier clinical trial data and observational studies. A marginally significant indication showed that vitamin supplementation is more effective in those with mild histopathology at baseline and younger than 45 years. Similarly, only participants aged less than 55 years benefited from factor D in the Linxian Nutrition Intervention Trial.34
Observational data show a decreased risk of gastric cancer with increased consumption of garlic and allium vegetables in Linqu12 and elsewhere.37 Garlic and its derivatives have antioxidative, antimicrobial, and immune modulation properties.3839 However, few long term randomized placebo controlled intervention trials have utilized dietary or supplemental allium vegetables for cancer prevention. One trial indicated that aged garlic extract prevented metachronous colorectal adenomas,40 whereas another revealed a statistically significant protective effect of synthetic diallyl trisulfide (allitridum) combined with selenium on gastric cancer incidence in men but not in women.41 After 22.3 years, garlic supplementation led to a non-statistically significant reduction in gastric cancer incidence and a statistically significant reduction in gastric cancer mortality, confirming favorable, but non-statistically significant trends seen at 14.7 years.8
H Pylori Treatment - How to Get Rid of H.Pylori Without Antibiotics
The time course and duration of protective effects is of interest. H pylori treatment was associated with retardation in the progression of precancerous gastric lesions,7 and evidence began to accumulate for protective effects on gastric cancer incidence and mortality in the initial trial period. The beneficial effects on gastric cancer incidence and mortality persisted during 14.7 years8 and again through 22.3 years (fig 3). Neither vitamin nor garlic supplementation significantly retarded histopathologic progression during the initial trial, ending at 2003.7 Vitamin supplementation showed favorable (but not statistically significant) effects on gastric cancer mortality during the trial period; these effects persisted during the extended follow-up over 14.7 and 22.3 years (fig 3). Favorable effects of vitamin supplementation on gastric cancer incidence appeared late but were apparent during the extended follow-up of 14.7 years and persisted. Garlic supplementation first showed favorable effects on gastric cancer incidence and mortality during the extended follow-up of 14.7 years; these effects also persisted. In Kaplan-Meier plots, we also observed that the effects on gastric cancer mortality became apparent after about eight years for H pylori treatment and vitamin supplementation and after about 12 years for garlic supplementation (fig 4). The mechanisms for these time patterns in treatment effects remain to be elucidated.
Although H pylori treatment represents a promising approach to prevention of gastric cancer, it did not eliminate gastric cancer incidence or mortality altogether, and some H pylori strains might become resistant to antibiotics. Other preventive modalities such as vitamin and garlic supplementation are of potential value. Because we found no evidence of negative interactions between H pylori treatment and the supplements, it is likely that combinations of these interventions can further reduce gastric cancer incidence and mortality. Even though nutritional and garlic supplements could take years to impact on gastric cancer incidence and mortality, they might prove less expensive, safe, and robust interventions in the long run.
Strengths and limitations of this study
Strengths of the Shandong Intervention Trial included excellent treatment compliance and long term follow-up, with virtually complete ascertainment of people with gastric cancer and cause specific deaths in a well defined high risk population. The study does, however, have several limitations. Firstly, the numbers of events were too small to be convincing for some causes of death in secondary analyses and also restricted the power for detailed subgroup and interaction analyses for gastric cancer. We do not have the information on cardia or non-cardia cancer for all people with gastric cancer, and the limited number precluded an analysis of cardia gastric cancer separately. Secondly, we cannot disentangle the effect of particular components of vitamin and garlic supplements or characterize a dose-response relation. Thirdly, we did not have information on participants’ H pylori infection status, non-trial treatments for H pylori, or nutritional and garlic supplementation after the trial ended in 2003. Although social and economic changes have occurred in China since 2003 and some participants might have changed their diets or lifestyles, it is unlikely that these changes would have differed by initial intervention assignment, because of the randomized masked trial design. Even so, studies are warranted to explore potential effects of changes in lifestyles and non-trial use of H pylori treatment or nutritional supplements. Fourthly, we conducted scheduled gastroscopies for participants during the trial period and for those with advanced gastric lesions during the extended follow-up. Ascertainment bias is unlikely during the trial period. However, a group with more advanced lesions in 2003 had a greater chance of endoscopically ascertained gastric cancer in extended follow-up. This could pertain to the placebo group for H pylori treatment, as such treatment, but not other interventions, retarded progression of gastric lesions.7 This could result in slight overestimates of the protective effect of H pylori treatment. Such bias is likely to be small, however, because most incident gastric cancer was diagnosed during the trial or through hospital records and not by trial prescribed endoscopy during extended follow-up. Fifthly, our study population was from a high risk rural area with nutritional deficiencies. Although the findings might have implications for populations worldwide, extrapolation to a well nourished population or a population with low incidence of gastric cancer might be problematic.
Conclusions and policy implications
We found statistically significantly decreased risks of gastric cancer incidence and mortality with short term H pylori treatment during 22.3 years of follow-up, showing the longest durable beneficial effect among the major randomized trials of H pylori treatment. Multiyear vitamin supplementation yielded statistically significant reductions in gastric cancer incidence and mortality. Garlic supplementation also yielded a statistically significant decrease in gastric cancer mortality and a promising, but not statistically significant, decrease in gastric cancer incidence. These findings suggest many potential strategies for gastric cancer prevention. However, before major public health campaigns for gastric cancer prevention are launched utilizing antibiotic based H pylori treatment or nutritional regimens, further large scale intervention trials are warranted to delineate the full range of beneficial and adverse effects of H pylori treatment, to confirm the preventive effects of vitamin and garlic supplementation, and to identify possible risks from nutritional regimens.
What is already known on this topic
Helicobacter pylori infection is an established risk factor for gastric cancer and H pylori eradication could be a potential strategy for preventing gastric cancer
The duration of effectiveness of H pylori treatment on gastric cancer prevention and the related full range of beneficial and adverse effects needs to be studied by long term follow-up
Few nutrition intervention trials have been done in populations with nutritional deficiencies, whereas nutrition supplementation effects on gastric cancer need to be assessed with long term follow-up
What this study adds
Short term H pylori treatment was associated with a significantly decreased risk of gastric cancer incidence and mortality during 22.3 years of follow-up and was not significantly associated with total mortality or other major cancer specific mortality
Both vitamin (C, E, and selenium) and garlic (extract and oil) supplementation for 7.3 years yielded statistically significant reductions in gastric cancer mortality, whereas a favorable effect of long term vitamin supplementation on gastric cancer incidence was also observed
These findings offer potential opportunities for gastric cancer prevention, but further large scale intervention trials are required to confirm the favorable effects of vitamin and garlic supplementation and to identify any possible risks of H pylori treatment, and vitamin and garlic supplementation
Acknowledgments
We thank Joseph F Fraumeni Jr (National Cancer Institute) for his help before and during the trial period; the residents, field staff, and government of Linqu County for supporting this trial; Wakunaga of America for performing assays of S-allyl cysteine and providing garlic supplements; Shanghai Squibb for providing vitamin supplements; and Astra Corporation for providing amoxicillin and omeprazole. These study sponsors attended a planning meeting in April 2005 at which elements of the protocol and provision of intervention materials were discussed, but these sponsors did not write or approve the protocol, participate in data collection (apart from providing assays for S-allyl cysteine), interpret the data, participate in writing this article, or influence the decision to submit this article for publication. We also thank members of the data safety and monitoring committee for guidance and oversight during the trial. This trial is also listed on the National Cancer Institute’s Physician Data Query database (No NCI-OH-95-C-N029; www.cancer.gov/clinicaltrials).
Footnotes
Contributors: WQL, KFP, and WCY were conceived and designed the study. WQL, JYZ, YG, KFP, and WCY acquired, analyzed, and interpreted the data. WQL and JYZ wrote the initial draft of the manuscript. WQL and JYZ contributed equally to this paper. All the authors were involved in preparing this manuscript and contributed to the critical revision of the manuscript. WQL, KFP, and WCY are guarantors. WCY supervised the study. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria were omitted.
Funding: This study was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute, and in part by National Cancer Institute contracts NO2-CP-71103 and NO2-CP-21169. Additional support was from the National Basic Research Program of China (973 program: 2004CB518702 and 2010CB529303). The funding sources had no role in the study design; collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The original trial and study extension were approved by review boards of Peking University Cancer Hospital, and the US National Cancer Institute, and participants provided written informed consent.
Data sharing: Further information on the trial design and follow-up available on request.
The lead author (WQL, KFP, and WCY) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Allium vegetables such as garlic have been used throughout history for their medical properties, for instance in treatment of infections. Several studies showed a decreased risk of gastric cancer with an increasing consumption of allium vegetables, 1 possibly by an effect on Helicobacter pylori as this organism is associated with gastric cancer.
For eradication of H. pylori, good results are obtained with a triple therapy consisting of the gastric acid inhibitor omeprazole and two antibiotics such as metronidazole, amoxycillin or clarithromycin. In vitro, an antibacterial effect of omeprazole on bacterial growth including H. pylori has been demonstrated. 2,3 As resistance of H. pylori to metronidazole, clarithromycin and tetracycline increases, reduction in the use of antibiotics is important to control the problem of antibiotic resistance.
We hypothesized that a possible synergic effect of garlic and antibiotics and garlic and omeprazole could result in a reduction in the use of antibiotics.
Materials and methods
The influence of garlic on bacterial growth was studied with five clinical isolates of H. pylori.
Fresh Spanish garlic was peeled and mashed in a blender. After filtration, the substance was freeze-dried and stored at −70°C until use. Commercial garlic tablets (Arizona 2000 TR, Kneipp and Wapiti 2000) kindly supplied by Nutrivital BV (Dronrijp, The Netherlands), Kneipp Nederland BV (Montfoort, The Netherlands) and Emonta BV (Drachten, The Netherlands) were pulverized with a mortar. Both the raw and commercial garlic tablets were dissolved in sterile distilled water before use.
Pure omeprazole, kindly supplied by Astra (Hässle, Sweden), was dissolved in 96% acidified ethanol, 10- 15 min before use to assure acid-catalysation.
Antibacterial effect of garlic on H. pylori
Susceptibility of H. pylori for garlic was determined by the agar dilution method using blood agar plates in miniwell format (Blood agar base no. 2 (Oxoid CM271, Basingstoke, UK) with 7% sheep blood) containing raw garlic extract or commercial garlic in concentrations of 0, 1000, 2000, 5000, 10,000, 12,500, 15,000 and 17,500 mg/L. Agar plates were inoculated with 0.01 mL of a H. pylori suspension (McFarland 3) and incubated for 4 days at 37°C under microaerophilic conditions (5% O 2, 10% CO 2). MIC values were also determined based on the allicin contents of the commercial garlic tablets.
The amount of thiosulphinates in the raw garlic extract was determined spectrophotometrically. Allicin is the major thiosulphinate produced by garlic and can be estimated by multiplying the value for total thiosulphinates by 0.7.
Combined influence of garlic and antibiotics
The combined effect of the home-made garlic extract and amoxycillin, clarithromycin and metronidazole on H. pylori was tested with blood agar plates containing either garlic 2000 mg/L alone or in combination with a quarter, once or twice the MIC values of amoxycillin (0.032 mg/L), clarithromycin (0.016 mg/L) or metronidazole (1 mg/L). Agar plates were inoculated with 0.1 mL of H. pylori suspension (McFarland 3) and incubated as described above.
Combined influence of garlic and omeprazole
The combined effect of garlic and omeprazole on H. pylori was tested with killing curves using Brain Heart Infusion broth pH 5 (Oxoid CM225) with 5% sheep blood. Combinations of garlic (500, 1000, 2000 or 4000 mg/L) and omeprazole (100 or 200 mg/L) as well as a suspension of H. pylori (inoculum size 10 5 cfu/mL) were added. From day 0 to day 7, a sample of 0.1 mL was taken and bacterial counts were assessed semi-quantitatively with the five segments method.
A control of bacterial growth and a control with acidified ethanol was included each time. All experiments were performed at least in duplicate.
Results
Effect of home-made and commercial garlic
Five clinical isolates of H. pylori were tested in triplicate. The median MIC values were 10,000 (range 5000- 10,000) mg/L for the raw garlic extract, 12,500 (range 10,000- 12,500) mg/L for Kneipp, 15,000 (range 12,500- 15,000) for Wapiti 2000 and >17,500 for Arizona 2000 TR. The allicin concentration is 0.77, 2.67 and 0.90 mg/tablet (including the coating) for Arizona 2000 TR, Kneipp and Wapiti 2000, respectively. For raw garlic extract the concentration of allicin determined spectrophotometrically was 12.3 mg/g garlic extract. If MIC values were based on the allicin contents of the commercial garlic tablets, MIC values for the three commercial garlic tablets were similar (40,000 mg/L).
As the antibacterial effect was strongest for the raw garlic extract and to circumvent a possible influence of the coating of the commercial garlic tablets, further experiments were performed with the raw garlic extract.
H pylori - From Diagnosis to Therapeutics
Combined effect of garlic and antibiotics
No synergic or antagonistic effect could be observed between garlic and amoxycillin, clarithromycin or metronidazole on H. pylori.
Combined effect of garlic and omeprazole
The combined effect of garlic and omeprazole on the growth of H. pylori tested with killing curves is shown in the Figure. Values are based on the mean of five clinical isolates tested in duplicate. Control growth of H. pylori varied between 10 4 and 10 7 cfu/mL during 7 days. In the presence of omeprazole (200 mg/L), garlic 2000 or 4000 mg/L, or combinations of both (see Figure, part a), no growth of H. pylori was observed after 24- 48 h. In the presence of omeprazole 100 mg/L (see Figure, part b), the number of H. pylori decreased slowly to zero within 7 days and a slight decrease of H. pylori was found in the presence of garlic 500 mg/L during the first 24- 48 h. In the presence of garlic 1000 mg/L the number of H. pylori decreased to 0- 10 1 cfu/mL during the first 3 days but rose again thereafter. A synergic effect was found when both omeprazole 100 mg/L and garlic 500 or 1000 mg/L were added, showing no bacterial growth after 24- 48 h.
Discussion
In this study, a growth inhibitory effect of garlic on H. pylori was observed. In addition, a synergic effect was found for the combination of garlic and omeprazole. However, no synergic or antagonistic effect was observed between garlic and amoxycillin, clarithromycin or metronidazole.
Several in-vitro studies have shown an antibacterial effect of allium vegetables. 4 The antibacterial activity varies with the species, production method and ripeness. 5 All experiments in this study were performed with one batch of garlic extract and commercial garlic tablets. An antibacterial effect of garlic was reported previously for both Gram-positive and Gram-negative bacteria, including antibiotic-resistant strains. 4 Recently, two studies also described an antibacterial effect of garlic against H. pylori.6,7
Garlic, like all allium vegetables, contains a wide range of thiosulphinates such as allicin which are thought to be responsible for the antibacterial activity. 4 Selective removal of the thiosulphinates or prevention of their formation by inhibition of alliinase eliminates the antibacterial activity of garlic. 4 When the commercial garlic tablets tested in this study were compared based on their allicin contents, no differences in antibacterial activity were found. Furthermore, the strongest antibacterial effects were observed for the raw garlic extract, which was found to have the highest concentration of allicin, supporting an important role for allicin in the antibacterial effects of garlic.
Theoretically, both thiosulphinates and omeprazole (a substituted benzimidazole) may have a similar mechanism for their antibacterial activity. As described for omeprazole, allicin can also bind to SH-groups of, for example, bacterial enzymes 8 and nutrients such as cysteine. 3,9 Competition between garlic and omeprazole for binding to available SH-groups may contribute to the synergic effects in relation to the concentrations of both substances. The presence of important enzymes in the cell membrane of H. pylori (such as urease) may contribute to the strong antibacterial effect of garlic and omeprazole against this micro-organism.
The MIC values for both raw garlic extract and the commercial garlic tablets were rather low, so that an in-vivo effect of garlic in the stomach seems possible. In-vivo studies have already shown the therapeutic potential of garlic in humans. 10 The gastric environment such as pH, temperature and dietary factors also influence the antibacterial activity of omeprazole and garlic compared with in-vitro conditions. The intragastric acidity is not expected to be a problem as omeprazole needs acid-catalysation for its antibacterial activity and an antibacterial effect of garlic was still found in the presence of a buffer with pH 2.
An antibacterial effect of garlic and a synergic effect of garlic in combination with omeprazole might be an interesting alternative therapy for H. pylori infections. Further studies concerning the combined effect of omeprazole and garlic are warranted.
Figure.
(a) Effect of omeprazole (200 mg/L) and
garlic
(2000 or 4000 mg/L) on growth of Helicobacter pylori. Open cross, control; closed
cross,
omeprazole 200 mg/L; ▵, garlic 2000 mg/L; ○, garlic 4000 mg/L; ▴, omeprazole
200
mg/L + garlic 2000 mg/L; •, omeprazole 200 mg/L + garlic 4000 mg/L. (b)
Effect of
garlic (100 mg/L) and garlic (500 or 1000 mg/L) on growth of Helicobacter pylori. Continuous line with cross, control; dotted line with cross, omeprazole 100 mg/L; ◊, garlic
500
mg/L; □, garlic 1000 mg/L; ⧫, omeprazole 200 mg/L garlic 500 mg/L;
▪
,
omeprazole 200 mg/L + garlic 1000 mg/L.
Open in new tabDownload slide
(a) Effect of omeprazole (200 mg/L) and garlic (2000 or 4000 mg/L) on growth of Helicobacter pylori. Open cross, control; closed cross, omeprazole 200 mg/L; ▵, garlic 2000 mg/L; ○, garlic 4000 mg/L; ▴, omeprazole 200 mg/L + garlic 2000 mg/L; •, omeprazole 200 mg/L + garlic 4000 mg/L. (b) Effect of garlic (100 mg/L) and garlic (500 or 1000 mg/L) on growth of Helicobacter pylori. Continuous line with cross, control; dotted line with cross, omeprazole 100 mg/L; ◊, garlic 500 mg/L; □, garlic 1000 mg/L; ⧫, omeprazole 200 mg/L garlic 500 mg/L; ▪ , omeprazole 200 mg/L + garlic 1000 mg/L.
*
Correspondence address. University Hospital Maastricht, Department of Medical Microbiology, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-43-3874644; Fax: +31-43-3876643.
References
1. Dorant, E., van den Brandt, P. A., Goldbohm, R. A. & Sturmans, F. (1996
2. McGowan, C. C., Cover, T. L. & Blaser, M. J. (1994
3. Jonkers, D., Stobberingh, E. & Stockbrügger, R. (1996Omeprazole inhibits growth of Gram-positive and Gram-negative bacteria including Helicobacter pylori in vitro. Journal of Antimicrobial Chemotherapy 37, 145–50.
4. Farbman, K. S., Barnett, E. D., Bolduc, G. R. & Klein, J.(1993Antibacterial activity of garlic and onions: a historical perspective. Pediatric Infectious Disease Journal 12, 613–4.
5. Feldberg, R. S., Chang, S. C., Kotik, A. N., Nadler, M., Neuwirth, Z., Sundstrom, D. C. et al. (1988
6. Cellini, L., Di Campli, E., Masulli, M., Di Bartolomeo, S. & Allocati, N.(1996
7. Sivam, G. P., Lampe, J. W., Ulness, B., Swanzy, S. R. & Potter, J. D.(1997
8. Reuter, H. D., Koch, H. P. & Lawson, L. D. (1996). Therapeutic effects and applications of garlic and its preparations. In Garlic: the Science and Therapeutic Application of Allium sativum L. and Related Species (Koch, H. P. & Lawson, L. D., Eds), pp. 162- 72. Williams and Wilkins, Baltimore, MD.
9. Rhodes, M. J. C. (1996
10. Hunan Medical College. (1980
The British Society for Antimicrobial Chemotherapy
What foods are bad for H. pylori?
Food that stimulates the secretion of gastric acid (such as coffee, black tea and soft drinks) and food that irritates the stomach lining (like pepper, and processed, fatty meats, such as bacon and sausage) should be avoided when treating an H. Pylori infection.
H. pylori is a bacterium which lodges in the stomach lining and usually causes gastritis, but, in some cases, this infection can also lead to other problems such as stomach cancer, ulcers, vitamin B12 deficiency, anemia, diabetes and a fatty liver. When its presence is confirmed, treatment as prescribed by your doctor is recommended.
There are foods that can compliment the recommended treatment. These foods include
1. Probiotics
Probiotics are present in foods such as yogurt and kefir, and can also be taken as supplements, in powder or capsule form. Probiotics are formed by good bacteria that live in the intestine and stimulate the production of flora that fight this bacteria and decrease the side effects that appear during the treatment of the disease, such as diarrhea, constipation and poor digestion.
2. Omega-3 and omega-6
Omega-3 and omega-6 help to reduce stomach inflammation and prevent the growth of H. pylori, helping to treat the disease. These good fats can be found in foods like fish oil, olive oil, carrot seeds and grapefruit seed oil.
3. Fruits and vegetables
Non-acidic fruits and boiled vegetables should be eaten during the treatment of H. pylori because they are easily digested and help to improve bowel function. Certain fruits like raspberries, strawberries, blackberries and blueberries help to fight the growth of this bacteria, and therefore moderate intake can be considered.
4. Broccoli, cauliflower and cabbage
These 3 vegetables, especially broccoli, contain substances called isothiocyanates which can help prevent cancer and fight H. pylori,. They help to reduce the spread of this bacteria in the intestine. These vegetables are easy to digest and help reduce gastric pain that can arise during treatment. 70g of broccoli a day (about 1/3 of a cup) is recommended for the best results.
Cure H. Pylori Naturally
5. White meats and fish
Protein that has lower fat content, like white meats and fish, help with digestion and prevent food from staying too long in the stomach (which can cause pain and a feeling of being full during treatment). The best way to prepare these proteins is by boiling them with salt and a bay leaf to add flavor without stimulating acid production in the stomach. If grilling the meat or fish, use olive oil or 1 tablespoon of water. Roasting meat, without oil, in the oven is also possible, but fried chicken and fish aren’t advisable.
How to relieve the treatment’s more unpleasant symptoms
Treatment for H. pylori usually lasts about 7 days and involves the use of medication, specifically proton pump inhibitors (e.g. omeprazole and pantoprazole) and antibiotics (e.g. amoxicillin and clarithromycin). These are taken twice a day. Learn more about the most common symptoms of H. Pylori and how it is treated.
Common side effects of H. Pylori medication are:
1. Metallic taste in the mouth
This can happen early on in the treatment, and can worsen over time. To help treat this problem, you can add vinegar to your salads and sprinkle baking soda and salt on your toothpaste before brushing your teeth. This will help both neutralize the acids in the mouth and produce more saliva, which can get rid of the metallic taste.
2. Nausea and stomach pain
Nausea and stomach pain usually appear from the second day of treatment onwards. To prevent these symptoms from happening, it is important to drink plenty of water, rest, and eat easily digestible foods such as yogurt, white cheeses, and crackers.
Drinking ginger tea shortly after waking up and eating 1 slice of toast or 3 crackers, as well as avoiding large amounts of fluids in one sitting, are good ways of relieving morning sickness.
3. Diarrhea
Diarrhea usually appears after the third day of treatment, because antibiotics, in addition to eliminating H. pylori, also end up reducing the naturally-occurring intestinal flora, causing diarrhea.
Eating 1 plain yogurt a day and easily digestible foods such as soups, purees, white rice, fish and white meats is a good way to stop diarrhea and restore the intestinal flora.
What to avoid eating during treatment
During treatment it is important to avoid eating foods that can irritate the stomach or that may stimulate the secretion of gastric juice, as well as foods that worsen side effects. It is important to avoid eating the following:
Coffee, chocolate and black tea, because they contain caffeine, a substance that stimulates stomach movement and gastric juice secretion, causing more irritation;
Soft drinks and fizzy drinks, as they distend the stomach and can cause pain and acid reflux;
Alcoholic beverages, because they increase stomach inflammation;
Sour fruits like lemon, orange and pineapple, as they can cause stomach pain and heartburn;
Pepper and spicy foods such as garlic, mustard, ketchup, mayonnaise, Worcester sauce, soy sauce, garlic sauce and stock cubes;
Fatty meats, fried foods and yellow cheeses, because they are rich in fat, which makes digestion difficult and increase the time that food stays in the stomach;
Processed meats and canned foods, as they contain a lot of preservatives and chemical additives that can irritate the stomach and intestine, increasing inflammation.
Therefore, drinking more water and eating white cheeses and fresh fruits that can help to reduce stomach inflammation and regulate intestinal transit is recommended.
3-day diet plan
The table below has an example of a 3-day menu to be followed during treatment:
Meal Day 1 Day 2 Day 3
Breakfast
1 plain yogurt + 1 slice of bread with white cheese and an egg.
Strawberry smoothie made with skim milk and oats.
1 glass of milk + 1 scrambled egg with white cheese.
Morning snack
2 slices of papaya + 1 teaspoon of chia seeds.
1 banana + 7 cashew nuts.
1 glass of green juice + 3 crackers.
Lunch/Dinner
4 tablespoons of rice + 2 tablespoons of beans + chicken with tomato sauce + cabbage salad.
Mashed potato + 1/2 piece of salmon + salad with steamed broccoli.
Vegetable soup made with cauliflower, potatoes, carrots, zucchini and chicken.
Afternoon snack
1 glass of skimmed milk + cereal.
1 plain yogurt + bread with red fruit jam.
Chicken sandwich with ricotta cream.
After treatment, it is important to always thoroughly clean fruits and vegetables before eating because H. pylori may be present in raw vegetables and infect the stomach again.
Can H. pylori be cured permanently?
Helicobacter pylori (H. pylori) is a gram-negative bacterium that causes chronic inflammation (infection) in the stomach and duodenum and is a common contagious cause of ulcers worldwide. These bacteria are sometimes termed "ulcer bacteria."
Helicobacter pylori cause chronic inflammation (gastritis) by invading the lining of the stomach and producing a cytotoxin termed vacuolating cytotoxin A (Vac-A) and thus can lead to ulcer formation.
Although many infected individuals have no symptoms, other infected individuals may have occasional episodes of
belching,
bloating,
nausea and vomiting, and
abdominal discomfort.
More serious infections cause symptoms of
abdominal pain,
nausea and vomiting that may include vomiting blood,
passing dark or tarry-like stools,
fatigue,
low red blood cell count (anemia),
decreased appetite,
diarrhea,
peptic ulcers,
heartburn, and
bad breath.
H. pylori are contagious; however, some individuals may simply have the bacteria in their gut, and the bacteria causes no symptoms of the disease.
The diagnosis of H. pylori infection includes tests for antibodies in the blood, a urea breath test, tests for antigens in stool, and endoscopic biopsies.
Chronic infections with Helicobacter pylori weakens the natural defenses of the stomach so most individuals with symptoms need to be treated to prevent ulceration formation.
H. pylori can be difficult to eradicate from the stomach with antibiotics because of antibiotic resistance; consequently, two or more antibiotics are usually given together (treatment regimen) with a proton pump inhibitor (PPI) medication (for example, omeprazole [Prilosec, Zegerid] or esomeprazole [Nexium]) termed H. pylori treatment and/or triple therapy.
In general, patients should be treated if they are infected with H. pylori and have ulcers. Moreover, patients who develop MALT lymphoma (a type of cancer) of the stomach have lymphoma progress if H. pylori are not treated and eradicated.
Because about 50% of the world's population is infected with H. pylori, treatment and prevention of side effects and complications are difficult; however, recommendations to help prevent ulcers include:
Reduce or stop alcohol intake and quit smoking.
Use acetaminophen (Tylenol and others) instead of NSAIDs, for example, aspirin, ibuprofen (Advil, Motrin).
Avoid caffeine.
Check for symptoms of H. pylori infection after radiation therapy.
Avoid or reduce stress.
Good handwashing techniques with uncontaminated water will reduce the chances of infection.
Currently, no vaccine is available against H. pylori to prevent either colonization or infection.
The prognosis for H. pylori infections is usually good to excellent, but up to 20% of affected individuals may have reoccurring infections. Untreated and more severe infections have a worse prognosis because of the potential for bleeding, anemia, and low blood pressure (hypotension).
What Is H. pylori, and Is It Contagious?
H. pylori (Helicobacter pylori) are spiral shaped bacteria. H. pylori bacteria are unique because they produce the enzyme urease that allows the bacteria to live in the harsh environment of the stomach. The urease enzyme it produces reacts with urea to form ammonia that neutralizes enough of the stomach's acid to allow the organisms to survive in the tissues.
Best Home Remedy for H pylori
H. pylori is considered to be contagious and passed from person to person by:
saliva,
fecal contamination (in food or water), and
poor hygiene practices.
Read more about H. pylori and how it is spread »
Infograph chart shows worldwide statistics for <i>Helicobacter pylori</i> (<i>H. pylori</i>).
Infograph chart shows worldwide statistics for Helicobacter pylori (H. pylori).Source: MedicineNet
What is Helicobacter pylori (stomach bacteria)?
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Helicobacter pylori (H. pylori or, as it is sometimes termed, stomach bacteria) is a spiral-shaped gram-negative bacterium that can cause chronic inflammation of the inner lining of the stomach (gastritis) and in the duodenum (first part of the small bowel) in humans. This bacterium also is considered a common cause of ulcers worldwide; as many as 90% of people with ulcers are infected with H. pylori. However, many people have these organisms residing in (colonizing or mucosa-associated) their stomach and upper digestive tract and have few or no symptoms. LPS (lipopolysaccharide) is part of the H. pylori outer membrane and can be toxic when the bacteria die and lyse.
Illustration of <i>Helicobacter Pylori</i> (<i>H. pylori</i>) infectious bacteria.
Illustration of Helicobacter Pylori (H. pylori) infectious bacteria. H. pylori infections start with a person acquiring the bacterium from another person (via either the fecal-oral or oral-oral route).Source: Getty Images
How do you get H. pylori?
H. pylori bacteria may cause a stomach infection in some individuals. H. pylori infections start with a person acquiring the bacterium from another person (via either the fecal-oral or oral-oral route). Although the majority of individuals who have these bacteria in their gastrointestinal (GI) tracts have few if any symptoms (see symptoms), most people develop stomach inflammation (gastritis) from the body's response to the bacterium itself and to a cytotoxin-associated substance termed Vac-A, a chemical that the bacterium produces.
Researchers also suggest that stomach acid stimulates the bacterium to grow and produce the cytotoxin, and increases invasion of the lining of the stomach by the bacteria, resulting in inflammation, and peptic ulcer formation (peptic ulcer disease). Other investigators have shown that these bacteria and their products cause alterations in the cells of the stomach lining that when altered are associated with stomach and other cancers, although these are infrequently seen diseases.
The frequency of people infected may somehow be related to race. About 60% of Hispanics and about 54% of African Americans have detectable organisms as compared to about 20% to 29% of White Americans. In developing countries, children are very commonly infected.
A woman experiences abdominal discomfort.
A woman experiences abdominal discomfort.Source: iStock
What are the early and serious symptoms and signs of Helicobacter pylori infections?
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Most individuals with Helicobacter pylori infections have few or no symptoms. Some may experience a few symptoms from mild gastritis episodes, for example,
minor belching,
bloating,
nausea,
vomiting, and
abdominal discomfort.
Often, these symptoms simply go away. However, those individuals who have more serious infection experience signs and symptoms of stomach and duodenal ulcers or severe gastritis which include:
Abdominal pain and/or discomfort that usually does not wax and wane
Nausea and vomiting sometimes with blood that is red, or the color is like coffee grounds or like vomitus
Dark or tar-like stools (black color of feces due to bleeding ulcers)
Fatigue
Low red blood cell counts due to bleeding
The full feeling after consuming a small amount of food
A decreased appetite that is more constant
Other symptoms may include:
Diarrhea
Heartburn
Bad breath (halitosis)
Persons with symptoms of black, tarry stools, and fatigue should seek immediate medical help or go to an emergency department to be evaluated for intestinal bleeding.
QUESTION
Bowel regularity means a bowel movement every day.
See Answer
Two women wearing medical masks to avoid infection.
Two women wearing medical masks to avoid infection. H. pylori are contagious.Source: iStock
Is H. pylori contagious?
Yes, H. pylori are contagious. However, sometimes there is a gray area between the terms contagious and colonized. Contagious usually implies that a disease-causing agent is transferred from person to person, while colonization usually implies an agent that simply populates an organ but does not cause disease, even when transferred from person to person. The gray area occurs when many people have the agent that causes disease in some of them, but not in many others. Some microbiologists consider such organisms as adapting to their human hosts by slowly changing from infecting humans to colonizing them. Although this is a speculation, it seems to fit the ongoing situation with H. pylori. However, others think the bacteria become infecting agents when H. pylori’s genetic makeup is triggered by the surrounding GI environment to produce and release enough toxic chemicals to cause the GI tract to become inflamed.
Which specialties of doctors treat H. pylori infection?
Many individuals can be treated by their primary care doctors; however, some people may need specialists like infectious disease specialists, gastroenterologists, and possibly a surgeon to help manage and/or treat the person with H. pylori infection.
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A male patient undergoes an endoscopy procedure for <i>H. pylori</i>.
A male patient undergoes an endoscopy procedure for H. pylori.Source: iStock
Is there a test to diagnose H. pylori infection?
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Accurate and simple tests for the detection of H. pylori infection are available (H. pylori infection tests). They include blood antibody tests, urea breath tests, stool antigen tests, and endoscopic biopsies.
Does Garlic Kill Good Bacteria?
Blood tests for the presence of antibodies to H. pylori can be performed easily and rapidly. However, blood antibodies can persist for years after complete eradication of H. pylori with antibiotics. Therefore, blood antibody tests (immunoglobulin G or IgG and/or IgA) may be good for diagnosing infection, but they are not good for determining if antibiotics have successfully eradicated the bacterium.
The urea breath test (UBT) is a safe, easy, and accurate test for the presence of H. pylori in the stomach. The breath test relies on the ability of H. pylori to break down the naturally occurring chemical, urea, into carbon dioxide, which is absorbed from the stomach and eliminated from the body in the breath. Ten to 20 minutes after swallowing a capsule containing urea labeled with either a minute amount of radioactive carbon or heavy but not radioactive carbon, a breath sample is collected and analyzed for labeled carbon dioxide. The presence of labeled carbon dioxide in the breath (a positive test) means that there is an active infection. The test becomes negative (there is no radioactive carbon dioxide in the breath) shortly after eradication of the bacterium from the stomach with antibiotics. Individuals who are concerned about even minute amounts of radioactivity can be tested with urea labeled with heavy, nonradioactive carbon.
Endoscopy is an accurate test for diagnosing H. pylori as well as the inflammation and ulcers that it causes. For endoscopy, the doctor inserts a flexible viewing tube (endoscope) through the mouth, down the esophagus, and into the stomach and duodenum. During endoscopy, small tissue samples (biopsies) from the stomach lining can be removed. A biopsy specimen is placed on a special slide containing urea (for example, CLO test slides). If the urea is broken down by H. pylori in the biopsy, there is a change in color around the biopsy on the slide. This means that there is an infection with H. pylori in the stomach. Endoscopy also allows the determination of the severity of gastritis with biopsies as well as the presence of ulcers, MALT lymphoma, and cancer.
Biopsies also may be cultured in the bacteriology laboratory for the presence of H. pylori; however, this is done infrequently since other simpler tests are available.
Stool sample: A recently-developed test for H. pylori is a test in which the presence of the bacterium can be diagnosed from a sample of stool. The test uses an antibody to H. pylori to determine if H. pylori antigen is present in the stool. If it is, it means that H. pylori are infecting the stomach. Like the urea breath test, in addition to diagnosing infection with H. pylori, the stool test can be used to determine if eradication has been effective soon after treatment.
In 2012, the FDA gave approval for the urea breath test to be done in children aged 3 years to 17 years old.
SLIDESHOW
Digestive Disorders: Common Misconceptions
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A woman takes antacids for stomach pain.
A woman takes antacids for stomach pain.Source: Getty Images
What treatment medications cure H. pylori infections?
Chronic infection with H. pylori weakens the natural defenses of the lining of the stomach to the ulcerating action of acid. Medications that neutralize stomach acid (antacids), and medications that decrease the secretion of acid in the stomach (H2-blockers and proton pump inhibitors or PPIs) have been used effectively for many years to treat ulcers.
H2-blockers include
famotidine (Pepcid, Zantac 360),
cimetidine (Tagamet), and
nizatidine (Axid).
PPIs include
omeprazole (Prilosec),
lansoprazole (Prevacid),
rabeprazole (Aciphex),
pantoprazole (Protonix), and
esomeprazole (Nexium).
Treating H. pylori with acid-reducing antacids, H2-blockers, and PPIs, however, does not eradicate H. pylori from the stomach, and ulcers frequently return promptly after these medications are discontinued. Hence, antacids, H2-blockers, or PPIs have to be taken daily for many years to prevent the return of the ulcers and the complications of ulcers such as bleeding, perforation, and obstruction of the stomach. Even such long-term treatments can fail.
Eradication of H. pylori, however, usually prevents the return of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. Eradication of H. pylori also is important in the treatment of the rare condition known as MALT lymphoma of the stomach.
Treatment of H. pylori to prevent stomach cancer is controversial and discussed in this article.
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A close-up of three glass prescription bottles.
A close-up of three glass prescription bottles. These combinations of medications can be expected to cure 70% to 90% of infections.Source: iStock
Is H. pylori infection easy to cure?
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H. pylori are difficult to eradicate (cure) from the stomach because it is capable of developing resistance to commonly used antibiotics (antibiotic-resistant H. pylori). Therefore, two or more antibiotics usually are given together with a PPI and/or bismuth-containing compounds to eradicate the bacterium. (Bismuth and PPIs have anti-H. pylori effects.) Examples of combinations of medications that are effective are:
a PPI, amoxicillin (Amoxil), and clarithromycin (Biaxin)
a PPI, metronidazole (Flagyl), tetracycline, and bismuth subsalicylate (Pepto-Bismol, Bismuth)
These combinations of medications can be expected to cure 70% to 90% of infections. However, studies have shown that resistance of H. pylori (failure of antibiotics to eradicate the bacterium) to clarithromycin is common among patients who have prior exposure to clarithromycin or other chemically similar macrolide antibiotics (such as erythromycin).
Similarly, H. pylori resistance to metronidazole is common among patients who have had prior exposure to metronidazole. In these patients, doctors have to find other combinations of antibiotics to treat H. pylori. Antibiotic resistance is another reason why antibiotics should be used carefully and judiciously for the right reasons, and indiscriminate use of antibiotics for improper reasons should be discouraged.
First-line regimens for Helicobacter pylori eradication or cure are taken from the guidelines developed by the American College of Gastroenterology as follows:
Standard dose of a *PPI (proton pump inhibitor) *b.i.d. (esomeprazole is *q.d.),clarithromycin 500 mg b.i.d., amoxicillin 1,000 mg b.i.d. for 10-14 days
Standard dose PPI b.i.d., clarithromycin 500 mg b.i.d. metronidazole 500 mg b.i.d. for 10-14 days
Bismuth subsalicylate 525 mg p.o. q.i.d. metronidazole 250 mg * p.o. *q.i.d., tetracycline 500 mg p.o. q.i.d., ranitidine 150 mg p.o. b.i.d. or standard dose PPI q.d. to b.i.d. for 10-14 days
PPI + amoxicillin 1 g b.i.d., for 5 days, followed by PPI, clarithromycin 500 mg, tinidazole 500 mg b.i.d. for 5 days (used mainly in other countries)
*PPI = proton pump inhibitor; pcn = penicillin; p.o. = orally; q.d. = daily; b.i.d. = twice daily; t.i.d. = three times daily; q.i.d. = four times daily.
A recent investigation reported that triple therapy of either levofloxacin (Levaquin) or rifabutin in combination with amoxicillin and esomeprazole yielded cure rates of 90% and 88.6%. The treatments lasted 10 to 12 days respectively (10 days of levofloxacin 20=50 mg b.i.d. or rifabutin 150 mg q.d. for 12 days. Amoxicillin dose was 1 gm, esomeprazole was 40 mg, both b.i.d.).
Some doctors may want to confirm eradication of H. pylori after treatment with a urea breath test or a stool antigen test, particularly if there have been serious complications of the infection such as perforation or bleeding in the stomach or duodenum. Endoscopic biopsies to determine eradication of the bacterium are not necessary, and blood tests are not good for determining eradication since it takes many months or years for the antibodies to H. pylori to decrease. The best tests for determining eradication are the breath and stool tests discussed previously. Patients who fail to eradicate H. pylori with treatment are retreated, often with a different combination of medications. Also, a meta-analysis study of patients started on low-dose aspirin showed less than 20% were tested for H. pylori; this is concerning because low-dose aspirin roughly doubles the risk factors for getting an upper GI bleed in individuals with H. pylori infection.
6 Proven Natural Remedies for H. Pylori
What natural treatments cure H. pylori infection?
There are many claims about natural treatment and cures for H. pylori infection. None of these have been scientifically proven to cure H. pylori infection, and include
mastic gum,
broccoli,
matuka tea,
manuka honey,
coconut oil, and
many others.
Discuss all natural herbs and supplements with your doctor before taking them.
Nutritionists and health care professionals suggest avoiding spicy foods, coffee, carbonated drinks, and pickled foods as these may increase the symptoms associated with the infection.
A doctor and patient discuss <i>H. pylori</i> treatment.
A doctor and patient discuss H. pylori treatment.Source: iStock
Does everyone have H. pylori bacteria in their stomach?
There is a consensus among doctors that individuals should be treated if they are infected with H. pylori and have ulcers. The goal of treatment is to eradicate the bacterium, heal ulcers if they are present, and prevent the ulcers' return. Patients with MALT lymphoma of the stomach also should be treated. MALT lymphoma is rare, but the tumor often quickly regresses upon successful eradication of H. pylori.
There currently is no formal recommendation to treat patients infected with H. pylori without ulcers or MALT lymphoma. Since antibiotic combinations can have side effects, and stomach cancers are infrequent in the United States, some health care professionals feel that the risks of treatment to eradicate H. pylori in patients without symptoms or ulcers may not justify the unproven benefits of treatment to prevent stomach cancer. On the other hand, H. pylori infection is known to cause atrophic gastritis (chronic inflammation of the stomach leading to atrophy of the inner lining of the stomach). Some doctors believe that atrophic gastritis can lead to cell changes (intestinal metaplasia) that can be precursors to stomach cancer. Studies have also shown that eradication of H. pylori may reverse atrophic gastritis. Thus, some doctors are recommending the treatment of ulcer- and symptom-free patients infected with H. pylori.
Many physicians believe that dyspepsia (non-ulcer symptoms associated with meals) may be associated with infection with H. pylori. Although it is not clear if H. pylori cause dyspepsia, many doctors will test patients with dyspepsia for infection with H. pylori and treat them if the infection is present.
Scientists studying the genetics of H. pylori have found different strains (types) of the bacterium. Some strains of H. pylori appear to be more prone to cause ulcers and stomach cancer. A meta-analysis of H. pylori eradication treatment seems to reduce gastric cancer risk. Further research in this area may help doctors intelligently select those patients who need treatment. Vaccination against H. pylori is unlikely to be available soon.
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Some nutritionists suggest a diet high in fruits and vegetables, and low in sugar may help reduce or stop <i>H. pylori</i> infection.
Some nutritionists suggest a diet high in fruits and vegetables, and low in sugar may help reduce or stop H. pylori infection.Source: Getty Images
Can you prevent H. pylori infections?
With at least 50% of the world population having detectable H. pylori in their stomachs, it seems likely that with no vaccine available, it will be very difficult or impossible for people to have no exposure to these bacteria. The chance of the organisms causing the symptomatic infection is low, but certainly not absent. Currently, suggestions have been made to prevent ulcers, but the effectiveness of these recommendations is unknown. The following is a list of recommendations to help prevent ulcers:
Reduce or stop the intake of alcohol.
Stop smoking.
For pain control, use acetaminophen (Tylenol and others) instead of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
Avoid caffeine in coffee and many "power" drinks.
Check for GI symptoms and treat immediately during or after radiation therapy.
Identify and reduce or avoid stress.
Wash hands with uncontaminated water to avoid contracting the bacterium.
If infected with H. pylori, antimicrobial treatment may prevent ulcer formation and extension of disease.
Currently, there is no commercially available vaccine to prevent either the infection or colonization of the stomach by H pylori. However, research is ongoing, and the NIH is funding vaccine studies in conjunction with vaccine makers (For example, Helicovax to prevent H. pylori colonization of human GI tracts by EpiVax, Inc.). Moreover, some nutritionists suggest that a diet high in fruits and vegetables, and low in sugar may help reduce or stop H. pylori infection. In many individuals, the immune response to infection is ineffective and leads to life-long infection.
What is the prognosis for H. pylori infections? What if it is not treated?
Many infections are mild and produce few if any, symptoms. The prognosis of these infections is excellent. Patients with more serious symptoms who are treated appropriately usually have a good prognosis although up to 20% may have a reoccurrence of the infection. Those with ulcers who have effective eradication of their infection heal their ulcers well (with usually minor scarring in the tissue).
Untreated and severe infections have a more guarded prognosis because extensive damage can occur with bleeding, scarring, anemia, and hypotension (low blood pressure) occurring. Some patients with these symptoms will die if not treated quickly. About 1% of people with the infection go on to develop gastric cancer. Researchers have suggested that it may be possible to use special inhibitors that will block the bacteria from adhering to the lining of the stomach gastric tissue.
How do you get rid of H. pylori naturally?
Helicobacter pylori (H. pylori) are bacteria that infect the lining of the stomach. These bacteria can cause peptic ulcer diseases and duodenal ulcers. While natural treatments may not eradicate the bacteria, they might help maintain the bacteria at low levels.
Gastric inflammation caused by H. pylori can lead to superficial gastritis, ulcers, and even gastric cancer. H. pylori infections typically require triple therapy with two antibiotics and a proton pump inhibitor.
Antibiotics can cause side effects. Using natural treatments might be helpful in preventing these side effects, protecting the stomach, helping the body to better fight infection, and promoting overall good health.
As natural treatments are unlikely to eradicate H. pylori entirely, people might choose to use them alongside conventional therapy.
Natural treatments for H. pylori
Researchers have conducted a range of studies on natural approaches to treating H. pylori infections. Eight potential natural treatments include:
How I cured my Acid Reflux and Helicobacter Pylori infection (without antibiotics)
1. Honey
People with H. pylori infections may find some natural treatments beneficial.
Honey is known for its antibacterial properties, and people have used it as a medicine since ancient times.
One study showed that Manuka honeyTrusted Source suppressed the growth of H. pylori in gastric epithelial cells.
Other studies have demonstrated that honey has other anti-H. pylori properties, but more animal studies and clinical trials are needed to assess honey’s efficiency as a complementary or alternative treatment.
2. Aloe vera
Aloe vera is an herbal remedy used to treat a variety of illnesses, including:
constipation
detoxification
digestive health
wound-healing
In one study, the gel from inside the leaves of an aloe veraTrusted Source plant was effective in both inhibiting growth of and killing H. pylori strains, even those that were drug-resistant in a laboratory environment.
This suggests that aloe vera could be effective against H. pylori infection when used in combination with antibiotics.
3. Broccoli sprout
Sulforaphane, a compound found abundantly in broccoli sprout, has been shown to kill H. pylori.
Studies performed both in test tubes and on animal and human subjects have demonstrated the favorable effects of sulforaphaneTrusted Source against H. pylori bacteria. Broccoli sprout also decreased gastric inflammation in H. pylori-infected mice.
4. Milk
Lactoferrin, a glycoprotein found in both human and cow’s milk, has shown inhibitory activity against H. pylori. One study used a combination of antibiotics and lactoferrin from cow’s milk, which resulted in a 100 percentTrusted Source eradication rate of H. pylori in 150 affected people.
Also, a compound called melanoidin appears to inhibit the growth of H. pylori bacteria. Melanoidin is a compound formed by a chemical reaction between the sugar lactose and a protein called casein in milk and dairy products. Research has shown that melanoidin suppressesTrusted Source H. pylori colonization in both mice and humans.
5. Lemongrass oil
People must not ingest essential oils. Instead, they can inhale them and use them as part of an aromatherapy approach. According to studies carried out on humans and animals, lemongrass essential oil inhibits the growth of H. pylori.
In a study on miceTrusted Source, the density of H. pylori colonization in the stomach was significantly reduced compared to mice not treated with lemongrass oil.
6. Green tea
Green tea is one of the healthiest and most widely consumed beverages in the world. It contains many antioxidants and nutrients.
In an animal study, green tea decreased both the number of bacteriaTrusted Source and the inflammation score of H. pylori-infected mice. However, researchers found that mice that received green tea before infection achieved better results.
7. Probiotics
According to the Food and Agriculture OrganizationTrusted Source, probiotics are live microorganisms that offer health benefits to people. Interest in probiotics as a treatment for H. pylori is increasing.
There are numerous types of probiotics. Many people use Bifidobacterium, which is found in dairy and fermented products, to prevent gastrointestinal infection.
Research has shown that Bifidobacterium exerts its effect against H. pylori by competing with the bacteriaTrusted Source to stick to the mucous lining of the stomach.
8. Phototherapy
Research suggests that H. pylori bacteria are sensitive to ultraviolet light. During phototherapy, an ultraviolet light source illuminates the whole stomach.
Phototherapy has been shown to reduce the number of bacteria in the stomach significantly. However, the bacteria will repopulate a few days after illumination.
While phototherapy is not a complete fix, it may have the potential to become an effective treatment against H. pylori, particularly for people who cannot take antibiotics.
When to see a doctor
Nausea can be a symptom of H. pylori infections.
Many people have H. pylori in their body for their entire lives and never have symptoms. Doctors do not routinely test for H. pylori. It is essential to get a correct diagnosis to receive proper treatment.
Symptoms of H. pylori infection may include:
abdominal pain
burning in the abdomen
bloating
nausea
reflux
loss of appetite
Anyone who is worried about symptoms should contact their doctor. Do not replace antibiotic treatments for H. pylori with natural treatments without discussing with a doctor.
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Takeaway
H. pylori is a widespread gastric infection that can lead to problems, such as gastric and duodenal ulcers.
It is becoming increasingly challenging to treat pylori as the bacteria have become resistant to conventional antibiotics.
There are some natural remedies which have been shown to be effective against H. pylori bacteria.
A person should speak with their doctor regarding starting natural treatments of H. pylori infection.
Herbs and supplements can interfere with some medications. The United States Food and Drug Administration (FDA) do not monitor supplements for quality and purity, so people should choose a reputable brand and speak to a doctor before trying them.
How do you get rid of H. pylori fast?
Helicobacter pylori(H. pylori) is a type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.
Infection with H. pylori is common. About two-thirds of the world’s population has it in their bodies. For most people, it doesn’t cause ulcers or any other symptoms. If you do have problems, there are medicines that can kill the germs and help sores heal.
Best Home Remedy for H pylori Updated
As more of the world gets access to clean water and sanitation, fewer people than before are getting the bacteria. With good health habits, you can protect yourself and your children from H. pylori.
How H. pylori Makes You Sick
For decades, doctors thought people got ulcers from stress, spicy foods, smoking, or other lifestyle habits. But when scientists discovered H. pylori in 1982, they found that the germs were the cause of most stomach ulcers.
After H. pylori enters your body, it attacks the lining of your stomach, which usually protects you from the acid your body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.
You can get H. pylori from food, water, or utensils. It’s more common in countries or communities that lack clean water or good sewage systems. You can also pick up the bacteria through contact with the saliva or other body fluids of infected people.
Many people get H. pylori during childhood, but adults can get it, too. The germs live in the body for years before symptoms start, but most people who have it will never get ulcers. Doctors aren’t sure why only some people get ulcers after an infection.
Symptoms
If you have an ulcer, you may feel a dull or burning pain in your belly. It may come and go, but you’ll probably feel it most when your stomach is empty, such as between meals or in the middle of the night. It can last for a few minutes or for hours. You may feel better after you eat, drink milk, or take an antacid.
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Other signs of an ulcer include:
Bloating
Burping
Not feeling hungry
Nausea
Vomiting
Weight loss for no clear reason
Ulcers can bleed into your stomach or intestines, which can be dangerous to your health. Get medical help right away if you have any of these symptoms:
Stool that is bloody, dark red, or black
Trouble breathing
Dizziness or fainting
Feeling very tired for no reason
Pale skin color
Vomit that has blood or looks like coffee grounds
Severe, sharp stomach pain
It’s not common, but H. pylori infection can cause stomach cancer. The disease has few symptoms at first, such as heartburn. Over time, you may notice:
Belly pain or swelling
Nausea
Not feeling hungry
Feeling full after you eat just a small amount
Vomiting
Weight loss for no reason
Getting a Diagnosis
If you don’t have symptoms of an ulcer, your doctor probably won’t test you for H. pylori. But if you have them now or have in the past, it’s best to get tested. Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage your stomach lining, so it’s important to find out what’s causing your symptoms so you can get the right treatment.
To start, your doctor will ask you about your medical history, your symptoms, and any medicines you take. Then they’ll give you a physical exam, including pressing on your belly to check for swelling, tenderness, or pain. You may also have:
Tests of your blood and stool, which can help find an infection
Urea breath test. You’ll drink a special liquid that has a substance called urea. Then you’ll breathe into a bag, which your doctor will send to a lab for testing. If you have H. pylori, the bacteria will change the urea in your body into carbon dioxide, and lab tests will show that your breath has higher than normal levels of the gas.
To look more closely at your ulcers, your doctor may use:
Upper gastrointestinal endoscopy. In a hospital, a doctor will use a tube with a small camera, called an endoscope, to look down your throat and into your stomach and the upper part of your small intestine. The procedure may also be used to collect a sample that will be examined for the presence of the bacteria. You may be asleep or awake during the procedure, but you’ll get medicine to make you more comfortable.
Upper GI tests. In a hospital, you’ll drink a liquid that has a substance called barium, and your doctor will give you an X-ray. The fluid coats your throat and stomach and makes them stand out clearly on the image.
Computed tomography (CT) scan. It’s a powerful X-ray that makes detailed pictures of the inside of your body.
If you have H. pylori, your doctor may also test you for stomach cancer. This includes:
Helicobacter Pylori 11 Foods to Eat and 5 to Avoid
Physical exam
Blood tests to check for anemia, when your body doesn’t have enough red blood cells. It could happen if you have a tumor that bleeds.
Fecal occult blood test, which checks your stool for blood that’s not visible to the naked eye
Endoscopy
Biopsy, when a doctor takes a small piece of tissue from your stomach to look for signs of cancer. Your doctor may do this during an endoscopy.
Tests that make detailed pictures of the insides of your body, such as a CT scan or magnetic resonance imaging (MRI)
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Treatment for H. pylori
If you have ulcers caused by H. pylori, you’ll need treatment to kill the germs, heal your stomach lining, and keep the sores from coming back. It usually takes 1 to 2 weeks of treatment to get better.
Your doctor will probably tell you to take a few different types of drugs. The options include:
Antibiotics to kill the bacteria in your body, such as amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl), tetracycline (Sumycin), or tinidazole (Tindamax). You’ll most likely take at least two from this group.
Drugs that reduce the amount of acid in your stomach by blocking the tiny pumps that produce it. They include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex).
Bismuth subsalicylate, which may also help kill H. pylori along with your antibiotics
Medicines that block the chemical histamine, which prompts your stomach to make more acid. These are cimetidine (Tagamet), famotidine Pepcid, Zantac 360), and nizatidine (Axid).
Your treatment could mean you’ll take 14 or more pills per day for a few weeks, which seems like a lot of medicine. But it’s really important to take everything that your doctor prescribes and to follow their instructions. If you don’t take antibiotics the right way, bacteria in your body can become resistant to them, which makes infections harder to treat. If your medications bother you, talk to your doctor about your treatment options and how you can handle side effects.
About 1-2 weeks after you finish your treatment, your doctor may test your breath or stool again to make sure the infection is gone.
Prevention
You can protect yourself from getting an H. pylori infection with the same steps you take to keep other germs at bay:
Wash your hands after you use the bathroom and before you prepare or eat food. Teach your children to do the same.
Avoid food or water that’s not clean.
Don’t eat anything that isn’t cooked thoroughly.
Avoid food served by people who haven’t washed their hands.
Though stress and spicy foods don’t cause ulcers, they can keep them from healing quickly or make your pain worse. Talk to your doctor about ways to manage your stress, improve your diet, and, if you smoke, how you can get help to quit.
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What can I expect after H. pylori infection?
Most ulcers caused by H. pylori will heal after a few weeks of treatment. If you’ve had one, you should avoid taking NSAIDs for pain, since these drugs can damage your stomach lining. If you need pain medicine, ask your doctor to recommend some.
Where can I find information or support?
You can find information about H. pylori infection and ulcers from the American College of Gastroenterology. For information on stomach cancer, as well as online and local support groups, visit the American Cancer Society.
What Herb kills H. pylori?
Helicobacter pylori (H. pylori) are bacteria that infect the lining of your stomach. According to 1998 data from the Centers for Disease Control and Prevention (CDC)Trusted Source, these bacteria are responsible for up to 80 percentTrusted Source of gastric ulcers and 90 percentTrusted Source of duodenal ulcers. They may also cause other stomach problems, including:
burning pain in the abdomen
bloating
nausea
loss of appetite
frequent burping
unexplained weight loss
The use of conventional treatments like antibiotics can be difficult for some people. It’s possible to experience negative side effects, such as nausea, diarrhea, loss of appetite. Some people are resistant to antibiotics, which can complicate traditional approaches to treatment. As a result, interest in natural treatments is growing.
7 natural treatments for H. pylori infection
Many in vivo and in vitro studies on natural H. pylori treatments have been done. Most treatments reduced the number of bacteria in the stomach but failed to permanently eradicate them.
Be sure to talk with your doctor before beginning a natural treatment regimen. You shouldn’t replace your recommend treatment for H. pylori with natural remedies.
With your doctor’s approval, you can use natural treatments as adjuvant therapy. This may increase the effects of conventional drugs.
Probiotics
Probiotics help maintain the balance between good and bad gut bacteria. According to a 2012 studyTrusted Source, taking probiotics before or after standard H. pylori treatment may improve eradication rates. Antibiotics kill both good and bad bacteria in your stomach. Probiotics help replenish good bacteria. They may also reduce your risk of developing yeast overgrowth. Researchers found evidence to suggest that the bacteria Lactobacillus acidophilus delivers the best results.
Green tea
A 2009 studyTrusted Source on mice showed that green tea may help kill and slow the growth of Helicobacter bacteria. The study found that consuming green tea before an infection prevents stomach inflammation. Consuming the tea during an infection reduced the severity of gastritis. Find a great selection of green tea here.
Honey
HoneyTrusted Source has shown antibacterial abilities against H. pylori. Additional research supports this conclusion. No research to date has shown that honey can eradicate the bacteria on its own. Researchers suggest that using honey with standard treatments may shorten treatment time. Raw honey and Manuka honey may have the most antibacterial effects.
Olive oil
Olive oil may also treat H. pylori bacteria. A 2007 study showed that olive oil has strong antibacterial abilities against eight H. pylori strains. Three of those strains are antibiotic-resistant. Olive oil also remains stable in gastric acid.
Licorice root
Licorice root is a common natural remedy for stomach ulcers. It may also fight H. pylori. According to a 2009 study, licorice root doesn’t directly kill the bacteria, though it can help prevent it from sticking to cell walls. There are a variety of options available for purchase online.
Broccoli sprouts
A compound in broccoli sprouts called sulphoraphane may be effective against H. pylori. Research on mice and humans suggests that it reduces gastric inflammation. It also may lower bacteria colonization and its effects. A studyTrusted Source on people with both type 2 diabetes and H. pylori showed that broccoli sprout powder fights the bacteria. It also improved cardiovascular risk factors.
Phototherapy
StudiesTrusted Source show that H. pylori are vulnerable to light. Phototherapy uses ultraviolet light to help eliminate H. pylori in the stomach. Researchers believe phototherapy used within the stomach is safe. It may be most beneficial when antibiotics are not an option.
I Eradicated My H. Pylori || H Pylori Protocol || Naturally Treat H Pylori
Traditional treatments for H. pylori infection
Doctors typically prescribe a combination of two antibiotics and an acid-reducing drug to treat H. pylori. This is known as triple therapy.
If you’re resistant to the antibiotics, your doctors may add another medication to your treatment plan. The goal is to get rid of 90 percent or more of the H. pylori bacteria present.
Treatment usually lasts no more than two weeks. Using two antibiotics instead of one may reduce your risk of antibiotic resistance. Antibiotics used to treat H. pylori include:
amoxicillin
tetracycline
metronidazole
clarithromycin
Acid-reducing medications help your stomach lining to heal. Some of these are:
proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid), which stop acid production in the stomach
histamine blockers, such as cimetidine (Tagamet), which block acid-triggering histamine
bismuth subsalicylate (Pepto-Bismol), which coats and protects the lining of your stomach
Outlook
Many people have the bacteria their entire lives and experience no symptoms. When it causes chronic gastric inflammation and remains untreated, serious complications may occur. These may include bleeding ulcers and stomach cancer. H. pylori is the main risk factor for some types of stomach cancer.
According to the 1998 data from the CDC, eradication rates of H. pylori are 61 to 94 percentTrusted Source when an FDA-approved antibiotic treatment is used. Rates are highest when antibiotics are combined with an acid reducer. Adding natural treatments may offer additional healing benefits.
Learn more: Acute gastritis »
WERBUNG
What you can do now
In the United States, doctors seldom test for H. pylori unless you have symptoms. If you have symptoms, call your doctor for an evaluation. H. pylori infection shares symptoms with other stomach conditions, such as acid reflux and GERD. It’s important you get the right diagnosis to make sure you’re treated correctly.
If you test positive for H. pylori, the sooner you start treatment, the better. Natural treatments aren’t likely to harm you, but they aren’t proven to eliminate the infection. Don’t use them instead of conventional treatments without your doctor’s supervision.
How to prevent future infection
The source of H. pylori is unclear. There are no formal recommendations from the CDC to prevent it. In general, you should practice good hygiene by frequently washing your hands and properly preparing your food. If you’re diagnosed with H. pylori, complete your full course of treatment to reduce your risk of recurrence.
Keep reading: Stomach ulcer »
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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.
Key Words: Helicobacter pylori, Urease Breath Test (UBT), Garlic, Stomach
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Introduction
Helicobacter pylori (H. pylori) is the most common bacterial infection in the world and is the most prevalent gastric bacterial pathogen in humans (Hekmatdoosta et al., 2015 ▶). In developed nations, the prevalence of this bacterium is 20-40% in adults while in developing countries the occurrence rate of this infection is relatively high; in fact, at the age of 20, 70-90% of the population are infected (Fennerty, 2005 ▶; Suerbaum and Michetti, 2002 ▶). H. pylori can cause chronic and active gastritis mainly affecting the antrum or fundus; it colonizes in the gastric mucosa and causes gastric inflammation in that region without even directly attacking the tissue. It is also capable of remaining in the area as colonized for a long time without any specific symptoms (Jabbari Nooghabi and jabbariNooghabi, 2008 ▶). H. pylori infection is associated with gastrointestinal diseases such as gastritis, peptic and duodenum ulcers, gastric adenocarcinoma, Malt lymphoma and non-gastrointestinal diseases including cardiovascular,thyroidand skin diseases, and other disorders such as autoimmune disorders, anemia, Guillain-Barré syndrome and migraine (Peterson et al., 2000 ▶).
Various treatment regimens which have their own benefits and side effects have been used to eliminate H. pylori infection. The most common regimen is triple therapy. This treatment consists of a proton pump inhibitor and two antibiotics, amoxicillin and clarithromycin for 7-14 days (Fuccio et al., 2008 ▶). There is also a quadruple regimen including omeprazole, bismuth and two antibiotics (metronidazole and tetracycline) prescribed for two weeks (Malfertheiner et al., 2000 ▶).
The biggest challenge regarding the eradication of H. pylori infection is the patients’ low tolerance for medical treatment and the resistance of this organism to antibiotics and other interventions. Eradication by triple therapy in the early studies has shown resistance in over 50% of patients for certain strains (Fauci et al., 2008 ▶), but in recent years, the three-drug regimens have shown progressive reduction in efficacy (less than 80% eradication rate). Not only the quadruple regimen is very costly but also the antibiotics used may cause an undesirable taste in the mouth along with diarrhea and itching. Moreover, among patients who have used metronidazole for a long time, seizure and poly-neuropathy have been reported. H. pylori can easily become resistant to clarithromycin and metronidazole; therefore, they cannot be prescribed after a single-treatment course (Meyer et al., 2002 ▶). In addition, Ozturk stated that following resistance to metronidazole, the efficiency of the prescribed treatment would be reduced down to 50% (Ozturk, 2008 ▶).
Despite different drug therapies, the rate of treatment failure due to resistance is around 5- 20%. Even in many cases with a completed treatment course, recurrence of the disease has been reported (Shoeibi et al., 2010 ▶). In this respect, the use of herbs and herbal medications may be beneficial due to theirnumerous medicinal effects. Todate, the antimicrobial effects of many herbal species (e.g.garlic) on H. pylori infection have been studied(Lee et al., 2003 ▶). Garlic has antibiotic, anti-cancer, antioxidant and anti-inflammatory properties; it can lower blood sugar levels and hasprotective effects on the cardiovascular system (Arreola et al., 2015 ▶; Hosseini and Hosseinzadeh, 2015 ▶; Mahdavi-Roshan et al., 2013 ▶; Rios et al., 2015 ▶; Wang et al., 2015 ▶). Furthermore, it is cheaper than many chemical drugs and easily accessible; therefore, it is generally better accepted by the patients resulting in a higher compliance rate (Bokaeian and Bameri, 2013 ▶). Several studies have assessed and reported the antibacterial effects of garlic on different bacteria (Sivam, 2001 ▶; Hosseini-Jazani et al., 2007 ▶). However, the results of McNulty et al. study did not show a significant relationship between garlic consumption and eradication of H. pylori infection (McNulty et al., 2008 ▶).
Given the high prevalence of gastrointestinal diseases in Iran, particularly gastric adenocarcinoma and its association with H. pylori, and considering the resistance of H. pylori infection to various treatment regimens, finding an appropriate medication for its eradication is of crucial importance. In the current study we aimed to explore the effect of garlic on H. pylori infection by using quantitative carbon 14 urease breath test (UBT).
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Materials and Methods
H. pylori detection techniques
H. pylori can be detected by several methods. Among them, few methods are able to quantitatively evaluate the activity of intra-mucosal live bacteria. Anti-H.pylori antibodies do not immediately decrease following treatment initiation and require eat least a few months. Therefore, the immediate level of antibodies in serum does not show the success of treatment. Endoscopy and biopsy are relatively aggressive techniques which cannot assess the early effects of treatment easily. Fecal antigens also show a lot of diversity. Quantitative UBT, on the other hand, can assess the early bacteriostatic effects of bacteria. By this method, the urease activity level of bacteria can be measured in a short time period (Count Per Minutes (CPM)).
Study design
In this pre-post-clinical trial, 15 patients with H. pylori infection were studied. The patients were enrolled by simple sampling. All patients who referred to the Gastroenterology clinic of Vali-Asr Hospital, Birjand, Iran from May 2013 to Jan 2014 with complaints of dyspepsia and gastrointestinal problems such as abdominal pain, loss of appetite, nausea and flatulence with a positive H. pylori IgG test were asked to participate in the study after fully explaining the study protocol. A questionnaire consisting of demographic data was completed for each participant and they were subsequently referred to Shafa Laboratory of Immunology, Birjand, Iran in order to completecarbon-14 urease breath test (UBT) for the diagnosis of active H. pylori infection.
The study protocol was approved by the Ethics Committee of Birjand University of Medical Sciences, Birjand, Iran and an informed consent was obtained from each participant prior to study entrance.
UBT conditions and performance
The conditions required for performing a quantitative UBT were as follows: fasting for at least 6 hours, no antibiotics and bismuth consumption during the last4 weeks, not having used any proton pump inhibitors, antacids, and histamine receptor blockers (e.g. ranitidine, famotidine and cimetidine) at least for a week and not smoking since one hour before the test. Each patient swallowed a C*14 urea capsule with a glass of water in the seated position and after 10 minutes they blew into a special breathing card; the respiratory card was placed in a plastic bag with aluminum coverage and was counted by a Gamma counter in the least possible time frame. In case of positivity of the gamma counter, the patient was diagnosed with active H. pylori infection and entered the study.
For three days, the patients were banned from consuming garlic or any other preparations of the alliums family, antibiotics and acid-reducing drugs. At the end of the three treatment-free days, the quantitative UBT count was performed once again and recorded as the control. Two medium cloves of raw garlic (3 g) were then administered toeach patient twice a day for 3 days with their daily meals. At the end of the 3-day treatment course, quantitative UBT counting was repeated for the patients, this time regarded as the cases.
Eat Garlic Every Day, And See What Happens to You
Statistical analysis
Gamma counter results, expressed as Count Per Minute (CPM), were analyzed by SPSS statistical software ver. 16 and the Kolmogorov-Smirnov test was applied to assess the normal distribution of the collected data. Since the data were normally distributed, intra- group ANOVA and Bonferroni tests were used to analyze the data at the significance level of p<0.05.
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Results
Fifteen patients, 4 (26.66%) male and 11 (73.33%) female were included in our study. The results of the intra-group analysis of variance showed that the mean UBT was significantly different between the cases (difference between the 2nd and 3rd measurements) and the control (difference between the 1st and 2nd measurements). Bonferroni test showed that the mean CPM in UBT after garlic consumption was significantly lower than the second test (p <0.005) and no significant difference was found between the mean CPM in UBT between the 1st and 2nd measurements (control) (p= 0.169) (Figure 1).
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Figure 1
Comparison of the mean CPM of C14-UBT before and after the intervention (CPM: Count per Minute
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Discussion
The results of this study showed that consumption of fresh garlic inhibits H. pylori activity inside the stomach mucosa to a great extent which indicates a bacteriostatic effect for garlic; bactericidal effects may take place at higher concentrations of garlic or following longer treatment courses. Various studies support the inhibitory effect of garlic on the growth of H. pylori (Jonkers et al., 1999 ▶).
In this context, Cutler and Wilson (2004) ▶ showed that garlic has a wide range of antibacterial activities and is also effective against H. pylori infection. Also, Ghobeh et al. (2010) ▶ reported that consumption of 4 gr of garlic powder leads to eradication of bacteria in 87% of H. pylori positive individuals. However, McNulty et al. (2008) ▶ study did not reveal any association between consumption of garlic powder and eradication of H. pylori infection.
Numerous studies have investigated the effect of garlic on various bacteria. Tsao et al. (2001) ▶ studied the effect of garlic oil and diallyltrisulfide and diallyltetrasulfide on Pseudomonas aeruginosa and showed that these elements potentially prevent or treat nosocomial infections and infections due to antibiotic-resistant strains of bacteria. Kazemizadeh et al. (2011) ▶ studied the effect of garlic extract on Enterococcus faecalis whereas Hosseini Jazini et al. (2007) ▶ studied the effect of garlic extract on multidrug-resistant Acinetobacter strains. These studies have pointed out the broad range of antibacterial effects of garlic.
In vitro administration of garlic extract at room temperature prevented the activity of gram negative bacteria such as Salmonella and E. coli and gram-positive bacteria including streptococcus type A and anthracis type B. Such inhibitory effects of garlic are even more marked than those of penicillin as 1mg of allicin is as effective as 15 standard units of penicillin (Farkhondeh and Aliporyegane., 2012).
The main components of garlicareorganosulfur (aleinandallicin), organic acids, carbohydrates and vitamins and the most important property of garlic, which is its antimicrobial effect, is attributed to allicin or garlic oil with 162.3 KD molecular weight.
Allicin is not naturally present in garlic cloves, but it is produced after hydrolysis and oxidation of alein. The mechanism(s) for the antimicrobial activity of allicin and garlic extract have not been yet fully investigated; however, a number of mechanisms have been suggested in this respect. Interference with the function of enzymes and proteins containing the sulfhydryl group (SH) is one of such mechanisms. Allicin irreversibly inhibits the SH proteases and NADP-dependent alcohol dehydrogenase (Shapoury et al., 2004 ▶). According to Inder and Qiutang (2002) ▶ study, garlic blocks the activity of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB ).This factor increases the expression of inflammatory cytokines and is one of the key molecules in inflammation and cancer. Activation of this nuclear factor is mediated byTLR4 receptor (Toll-like receptors). TLR4 are involved in induction of immune responses. Many of these receptors contain cysteine in their extracellular and cytoplasmic sectors (Iwalokun et al., 2004 ▶).
In addition, allicin in garlic contains compounds called thiosulfinate that can interact with cysteine. As a result, allicin can react with the cysteine which is in the structure of these receptors resulting in the inhibition of signaling pathways associated with TLR4 on the surface of cellular receptors. Allicin prevents the activation of NF-κB by inhibiting TLR4 signaling. This inhibition is considered as one of the main mechanisms via which garlic induced itsanti-inflammatory effects (Ghobeh et al., 2010 ▶).
Furthermore, H. pylori produces Heat Shock Proteins (HSP), urease and lipopolysaccharidase which are absorbed by the stomach epithelial cells. Following absorption, they pass through the mucous and synthesize inflammatory factors such as CRP, IL-8 and TNF-a (Hekmatdoosta et al., 2015 ▶).
Iwalokun et al. (2004) ▶ findings suggest that garlic extract is effective on the pathogenesis of toxic bacteria by preventing the toxin production. Moreover, it has been noted that allicin can reduce H. pylori infection by blocking nitrous synthesis and scavenging bnitrates and free radicals from the body.
This study had certain limitations; the study population was small and the effect of garlic was not compared with the routine anti-H. pylori regimens.
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Acknowledgment
The authors would like to thank of the Vice Chancellor for Research of Birjand University of Medical Sciences for their approval and financial support of this study.
Helicobacter pylori(H. pylori) is a type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of your stomach or the upper part of your small intestine. For some people, an infection can lead to stomach cancer.
Infection with H. pylori is common. About two-thirds of the world’s population has it in their bodies. For most people, it doesn’t cause ulcers or any other symptoms. If you do have problems, there are medicines that can kill the germs and help sores heal.
As more of the world gets access to clean water and sanitation, fewer people than before are getting the bacteria. With good health habits, you can protect yourself and your children from H. pylori.
How H. pylori Makes You Sick
For decades, doctors thought people got ulcers from stress, spicy foods, smoking, or other lifestyle habits. But when scientists discovered H. pylori in 1982, they found that the germs were the cause of most stomach ulcers.
After H. pylori enters your body, it attacks the lining of your stomach, which usually protects you from the acid your body uses to digest food. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers. These may bleed, cause infections, or keep food from moving through your digestive tract.
You can get H. pylori from food, water, or utensils. It’s more common in countries or communities that lack clean water or good sewage systems. You can also pick up the bacteria through contact with the saliva or other body fluids of infected people.
Many people get H. pylori during childhood, but adults can get it, too. The germs live in the body for years before symptoms start, but most people who have it will never get ulcers. Doctors aren’t sure why only some people get ulcers after an infection.
Symptoms
If you have an ulcer, you may feel a dull or burning pain in your belly. It may come and go, but you’ll probably feel it most when your stomach is empty, such as between meals or in the middle of the night. It can last for a few minutes or for hours. You may feel better after you eat, drink milk, or take an antacid.
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Other signs of an ulcer include:
Bloating
Burping
Not feeling hungry
Nausea
Vomiting
Weight loss for no clear reason
Ulcers can bleed into your stomach or intestines, which can be dangerous to your health. Get medical help right away if you have any of these symptoms:
Stool that is bloody, dark red, or black
Trouble breathing
Dizziness or fainting
Feeling very tired for no reason
Pale skin color
Vomit that has blood or looks like coffee grounds
Severe, sharp stomach pain
It’s not common, but H. pylori infection can cause stomach cancer. The disease has few symptoms at first, such as heartburn. Over time, you may notice:
Belly pain or swelling
Nausea
Not feeling hungry
Feeling full after you eat just a small amount
Vomiting
Weight loss for no reason
Getting a Diagnosis
If you don’t have symptoms of an ulcer, your doctor probably won’t test you for H. pylori. But if you have them now or have in the past, it’s best to get tested. Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) can also damage your stomach lining, so it’s important to find out what’s causing your symptoms so you can get the right treatment.
To start, your doctor will ask you about your medical history, your symptoms, and any medicines you take. Then they’ll give you a physical exam, including pressing on your belly to check for swelling, tenderness, or pain. You may also have:
Tests of your blood and stool, which can help find an infection
Urea breath test. You’ll drink a special liquid that has a substance called urea. Then you’ll breathe into a bag, which your doctor will send to a lab for testing. If you have H. pylori, the bacteria will change the urea in your body into carbon dioxide, and lab tests will show that your breath has higher than normal levels of the gas.
To look more closely at your ulcers, your doctor may use:
Upper gastrointestinal endoscopy. In a hospital, a doctor will use a tube with a small camera, called an endoscope, to look down your throat and into your stomach and the upper part of your small intestine. The procedure may also be used to collect a sample that will be examined for the presence of the bacteria. You may be asleep or awake during the procedure, but you’ll get medicine to make you more comfortable.
Upper GI tests. In a hospital, you’ll drink a liquid that has a substance called barium, and your doctor will give you an X-ray. The fluid coats your throat and stomach and makes them stand out clearly on the image.
Computed tomography (CT) scan. It’s a powerful X-ray that makes detailed pictures of the inside of your body.
If you have H. pylori, your doctor may also test you for stomach cancer. This includes:
Physical exam
Blood tests to check for anemia, when your body doesn’t have enough red blood cells. It could happen if you have a tumor that bleeds.
Fecal occult blood test, which checks your stool for blood that’s not visible to the naked eye
Endoscopy
Biopsy, when a doctor takes a small piece of tissue from your stomach to look for signs of cancer. Your doctor may do this during an endoscopy.
Tests that make detailed pictures of the insides of your body, such as a CT scan or magnetic resonance imaging (MRI)
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Treatment for H. pylori
If you have ulcers caused by H. pylori, you’ll need treatment to kill the germs, heal your stomach lining, and keep the sores from coming back. It usually takes 1 to 2 weeks of treatment to get better.
Your doctor will probably tell you to take a few different types of drugs. The options include:
Antibiotics to kill the bacteria in your body, such as amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl), tetracycline (Sumycin), or tinidazole (Tindamax). You’ll most likely take at least two from this group.
Drugs that reduce the amount of acid in your stomach by blocking the tiny pumps that produce it. They include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex).
Bismuth subsalicylate, which may also help kill H. pylori along with your antibiotics
Medicines that block the chemical histamine, which prompts your stomach to make more acid. These are cimetidine (Tagamet), famotidine Pepcid, Zantac 360), and nizatidine (Axid).
Your treatment could mean you’ll take 14 or more pills per day for a few weeks, which seems like a lot of medicine. But it’s really important to take everything that your doctor prescribes and to follow their instructions. If you don’t take antibiotics the right way, bacteria in your body can become resistant to them, which makes infections harder to treat. If your medications bother you, talk to your doctor about your treatment options and how you can handle side effects.
About 1-2 weeks after you finish your treatment, your doctor may test your breath or stool again to make sure the infection is gone.
Prevention
You can protect yourself from getting an H. pylori infection with the same steps you take to keep other germs at bay:
Wash your hands after you use the bathroom and before you prepare or eat food. Teach your children to do the same.
Avoid food or water that’s not clean.
Don’t eat anything that isn’t cooked thoroughly.
Avoid food served by people who haven’t washed their hands.
Though stress and spicy foods don’t cause ulcers, they can keep them from healing quickly or make your pain worse. Talk to your doctor about ways to manage your stress, improve your diet, and, if you smoke, how you can get help to quit.
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What can I expect after H. pylori infection?
Most ulcers caused by H. pylori will heal after a few weeks of treatment. If you’ve had one, you should avoid taking NSAIDs for pain, since these drugs can damage your stomach lining. If you need pain medicine, ask your doctor to recommend some.
Where can I find information or support?
You can find information about H. pylori infection and ulcers from the American College of Gastroenterology. For information on stomach cancer, as well as online and local support groups, visit the American Cancer Society.
Helicobacter pylori (H. pylori) infection occurs when H. pylori bacteria infect your stomach. This usually happens during childhood. A common cause of peptic ulcers, H. pylori infection may be present in more than half the people in the world.
Most people don't realize they have H. pylori infection, because they never get sick from it. If you develop signs and symptoms of a peptic ulcer, your doctor will probably test you for H. pylori infection. If you have H. pylori infection, it can be treated with antibiotics.
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Symptoms
Most people with H. pylori infection will never have any signs or symptoms. It's not clear why this is, but some people may be born with more resistance to the harmful effects of H. pylori.
When signs or symptoms do occur with H. pylori infection, they may include:
An ache or burning pain in your abdomen
Abdominal pain that's worse when your stomach is empty
Nausea
Loss of appetite
Frequent burping
Bloating
Unintentional weight loss
When to see a doctor
Make an appointment with your doctor if you notice any persistent signs and symptoms that worry you. Seek immediate medical help if you experience:
Severe or persistent abdominal pain
Difficulty swallowing
Bloody or black tarry stools
Bloody or black vomit or vomit that looks like coffee grounds
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Causes
The exact way H. pylori infects someone is still unknown. H. pylori bacteria may be passed from person to person through direct contact with saliva, vomit or fecal matter. H. pylori may also be spread through contaminated food or water.
Risk factors
H. pylori infection is often acquired in childhood. Risk factors for H. pylori infection are related to living conditions in your childhood, such as:
How i got RID of HPYLORI
Living in crowded conditions. You have a greater risk of H. pylori infection if you live in a home with many other people.
Living without a reliable supply of clean water. Having a reliable supply of clean, running water helps reduce the risk of H. pylori.
Living in a developing country. People living in developing countries, where crowded and unsanitary living conditions may be more common, have a higher risk of H. pylori infection.
Living with someone who has an H. pylori infection. If someone you live with has H. pylori infection, you're more likely to also have H. pylori infection.
Complications
Ulcers
UlcersOpen pop-up dialog box
Complications associated with H. pylori infection include:
Ulcers. H. pylori can damage the protective lining of your stomach and small intestine. This can allow stomach acid to create an open sore (ulcer). About 10% of people with H. pylori will develop an ulcer.
Inflammation of the stomach lining. H. pylori infection can irritate your stomach, causing inflammation (gastritis).
Stomach cancer. H. pylori infection is a strong risk factor for certain types of stomach cancer.
Prevention
In areas of the world where H. pylori infection and its complications are common, doctors sometimes test healthy people for H. pylori. Whether there is a benefit to testing for H. pylori infection when you have no signs or symptoms of infection is controversial among doctors.
If you're concerned about H. pylori infection or think you may have a high risk of stomach cancer, talk to your doctor. Together you can decide whether you may benefit from H. pylori screening.
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