H pylori and Probiotics

The combination of H pylori and probiotics for this gastrointestinal (GI) infection makes sense because both influence the body: the first with potential harm, and the latter with numerous benefits within and beyond the GI tract. In this article you will learn a brief introduction to the bacterium, traditional treatment for infections, and exciting research on probiotics that may help.

The Story of Helicobacter pylori

Helicobacter pylori, as the name suggests, is a helical- or spiral-shaped Gram-negative bacterium. It can survive with tiny amounts of air. In addition to the helical shape, it also has flagella, whip-like appendages, which allow it to move about. If it doesn't like one area, it can move to the next. It is generally considered to be a pathogen.

The bacterium has strong enzyme activity to neutralize your stomach (gastric) acid that allows it to survive and drill into in your stomach lining. When numbers reach an amount to cause a detectable infection, the infection triggers your immune system to attempt to kill it. Unfortunately, your immune system attempt causes collateral damage by damaging the gastric epithelial lining, which then allows H. pylori to flourish. As it flourishes, you experience symptoms of peptic ulcer disease and are a target for other pathogens to establish themselves farther down the GI tract.

Does H pylori Need to Be Killed?

H pylori is a bacterium that is associated with several gastrointestinal diseases such as chronic gastritis, gastric and duodenal ulcers, MALT-lymphoma and gastric cancer. It is also implicated in having a role in neurodegenerative diseases such as Alzheimer's disease.

You have probably heard that if it is present, it must be eradicated. While the first part of the previous sentence is true, the last part is debatable. In fact, epidemiological analyses revealed that nearly one-third of the population of North Europe and North America was infected with H. pylori, whereas in Southern and Eastern Europe, South America, and Asia, more than half the population had it.

Only a small percentage of those people will develop clinical manifestations of disease from it, however. Additionally, although found in children, H pylori infection often has a long incubation period of 10-20 years, so infection-related symptoms are usually not immediately experienced. That allows plenty of time for less-disruptive courses of action, particularly if someone is asymptomatic.

According to the Mayo Clinic, in individuals infected with H pylori, there is a 10% to
20% lifetime risk of peptic ulcer disease and 1% to 2% risk of gastric cancer. Do those risks warrant eradication? In some cases, yes, and in other cases, no. There are proponents on both sides of the debate. Bioindividuality of the person plays a role, as does the strain of H. pylori a person is infected with, as some strains, such as those positive for CagA, are more virulent.

Traditional H pylori treatment consists of a 10- to 14-day course of standard triple therapy, which consists of a proton-pump inhibitor, amoxicillin, and clarithromycin. The proton-pump inhibitor is usually taken for 3-5 weeks. Another therapy contains two antibiotics, tetracycline and metronidazole, plus bismuth and proton-pump inhibitor for 14 days. Then there are variations of those therapies. What you may not know, and should not be surprised by, is that in many cases, H. pylori is resistant to antibiotics, and eradication rates rarely exceed 80%. So what can you do? Consider an approach with H pylori and probiotics.

H pylori and Probiotics – The Research

H pylori and probiotics as a duo has research to support it. Probiotics can help with an H pylori infection in keeping it in controllable numbers and reducing the damaging inflammation it causes. And unlike the traditional therapy, probiotics won't cause widespread side effects and gut disruption.

To date, the conventional use of H pylori and probiotics have focused on the probiotics being used solely as an add-on to standard treatment to prevent adverse effects. Research studies, however, show that use of probiotics with conventional treatment increases the eradication rate of infection.

For example, a small, randomized, double-blind study in children diagnosed with H pylori infection via endoscopy showed that the addition of what now is called Bio-Kult Infantis (available in my online dispensary) with 7 strains of probiotics (1 sachet/day, 1 billion CFU, Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus bulgaricus, Lactobacillus casei, Streptococcus thermophilus, Bifidobacterium infantis and Bifidobacterium breve) improved eradication rates.

The 44 patients, ranging in age from 3 to 14,  in both standard treatment and standard treatment-plus-probiotics groups, demonstrated improvement in clinical symptoms after treatment. The group treated with the combination of probiotic and standard treatment regimen, however, showed a more significant eradication rate (90.09% versus 69.69%) as verified by a stool antigen test.

A larger study on H pylori and probiotics was performed in 641 adult patients. Of the total number, 192 received amoxicillin with clarithromycin and proton pump inhibitor, 241 received tetracycline, tinidazole, bismuth and proton-pump inhibitor, and 53 took amoxicillin with clarithromycin and proton-pump inhibitor (PPI) supplemented with a combination of L. helveticus R052 and L. rhamnosus R011 (see below). The efficacy of eradication treatment was evaluated by the (13)C-urease breath test.

The study demonstrated low efficacy of the tetracycline, tinidazole, bismuth and PPI scheme at  71.4% eradication rate, and moderate efficacy of the amoxicillin with clarithromycin and PPI combination at 85.9% eradication. The probiotics combination added to conventional treatments significantly increased the efficacy of eradication to 94.3%.

The recent study highlighted below shows that some probiotics have eradication properties of their own.  

Two probiotics from the Lactobacillus family were found to be beneficial against H pylori:

  1. L. acidophilus GMNL-185, and
  2. L. rhamnosus GMNL-74.

A total of 226 Lactobacillus strains from GenMont Biotech, Taiwan were screened for their ability to inhibit the adhesion and invasion of the pathogen to gastric epithelial cells. GMNL-74 and GMNL-185 had the most potent activities against the pathogen in vitro.

The H pylori (HP) used in the study were a reference strain, 26695, and 2 multi-drug-resistant, clinical isolates. These isolates were shown to be resistant to the antibiotics metronidazole and clarithromycin.

The study had several investigations of the H pylori and probiotics connection:

  • Anti-HP activity was determined by adding live probiotics to the HP cultures
  • Assays for HP adhesion and invasion into human stomach adenocarcinoma (cancer) (AGS) cell line were performed with live or heat-inactivated Lactobacillus strains
  • NF-kB, an immune marker, was measured when AGS cells were treated with the probiotics and then the HP
  • IL-8, another immune marker, was measured in the same manner as NF-kB
  • CagA (cytotoxin-associated gene A), an HP virulence factor involved in inflammation and implicated in the initiation of cancers such as MALT-lymphoma and gastric adenocarcinoma, was investigation in the same manner as NF-kB
  • An animal study with mice was performed. Mice were divided into four groups, including an untreated control, HP inoculation, treatment with GMNL-74 and HP infection, or treatment with GMNL-185 and HP infection. Mice fed with the probiotics received a dosage of 8.2 million CFU for a total of 24 days. Mice infected with HP received 100 million CFU at days 8, 10, 12, 14, 16, and 18.
  • Stool was collected at Day 0 and Day 24 and characterized for microbes.

The results were of the H pylori and probiotics impressive:

  • L. acidophilus GMNL-185 and L. rhamnosus GMNL-74 had strong anti-HP activity in vitro
  • L. acidophilus GMNL-185 and L. rhamnosus GMNL-74 exhibited strong HP anti-adhesion activity (93.2% and 96.7%, respectively) and dramatically inhibited HP invasion into AGS cells with reductions over 99%
  • HP infection induces NF-kB activation and IL-8 production. These cytokines contribute to the inflammation of gastric epithelial cells. Both probiotics reduced NF-kB and IL-8.
  • CagA decreased significantly in probiotic-treated cultures
  • Mice treated with probiotics showed NEGATIVE stomach test results for HP, just like the controls, plus the probiotics-treated groups had reduced levels of other inflammatory chemicals, COX-2 and TNFa, as well as reduced levels of inflammatory cells.
  • Stool analysis showed that the probiotics altered the microbiota. Although no definite conclusions can be made, Bifidobacterium species and A. muciniphilia, which are known to be beneficial, were abundantly present in HP-infected mice treated with probiotics, while pathogenic E. coli and Clostridium cluster 1 were decreased.

The overall findings of this study are consistent with those from previous studies: When indicated, treat H pylori and probiotics can be part of the resolution of the problem. Probiotics compete with HP adhesion to epithelia, thereby inhibiting the release of inflammatory cytokines, and alleviating gastric inflammation. Probiotics can also directly antagonize HP. The study's authors recommended that the probiotics GMNL-74 and GMNL-185 be developed to be used as prevention to inhibit HP infection and to alleviate inflammation.

H pylori and Probiotics – The Case for Prevention

As the authors in the GMNL study concluded, probiotics can be used as preventives against HP. Remember that in many cases, HP infection symptoms have a long incubation period of 10-20 years. That is plenty of time to interrupt its growth. Probiotics can also be used to mitigate side effects of conventional treatment.

You don't have to wait to be infected with a serious infection by HP to benefit from probiotics, and if you are infected, probiotics can assist in recovery. When dealing with HP infection, consider the relationship between H pylori and probiotics, particularly probiotics in the Lactobacillus family, which generally are antagonistic to many different pathogens.

Note that activity against HP appears to be strain-specific, as only 2 of the 226 Lactobacillus strains investigated in the study were found to have potent activity against HP

Unfortunately, the strains used in the recent aforementioned study are currently laboratory strains, not available to the general public at the time of this writing, but the BioKult Infantis is available in my online dispensary and a probiotic supplement, NuMedica Tri-Flora, with L. helveticus R052 and L. rhamnosus R011 in its formula, is also available in my dispensary. Please contact me if you wish to purchase the supplement used in the adult study.

If you would like help in recovering from or being proactive against HP, consider nutritional consultations with me.

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