Helicobacter Pylori and Heartburn
What is Helicobacter Pylori?
Helicobacter pylori or H. pylori is a highly developed bacteria found in the upper gastrointestinal tract of more than 50% of the world’s population.1 It is most prevalent in developing countries and less so in industrialized societies.2
Helicobacter pylori causes gastritis, an inflammation of the stomach lining. It can cause ulcers in the stomach and the duodenum, the upper section of the small intestine just below the stomach. Its presence can even lead to cancer.3
For the purpose of this article, we will focus on how Helicobacter pylori relates to heartburn, how it can be prevented, and how it is treated.
How Helicobacter Pylori Relates to Heartburn
The relationship between Helicobacter pylori and heartburn has been studied for years with no definitive conclusion. Let’s look at why Helicobacter pylori might have a negative or positive effect on gastroesophageal reflux disease (GERD), a chronic condition where acid refluxes into the esophagus causing heartburn.4,5,6 The controversy revolves around acidity levels and possible benefit of lower acid levels. Some studies show a direct connection between Helicobacter pylori and GERD, some show an inverse connection, and others show no connection at all.
Possible Direct Connection of Helicobacter pylori and GERD
Stomach acids and digestive enzymes break down food along with most bacteria and viruses. Helicobacter pylori has evolved to adapt to the harsh environment of the stomach. The unique shape of this bacteria allows it to penetrate and survive in the protective mucus that lines the stomach. In addition, it protects itself from stomach acids that penetrate the mucus by producing urease, an enzyme that converts urea found in the stomach into bicarbonate and ammonia. The result is a layer of protection that neutralize acids surrounding it.3 As overall stomach acid is neutralized, Helicobacter pylori and other harmful bacteria thrive.7,8 These other harmful bacteria can cause small intestine bacterial overgrowth (SIBO). SIBO and reduced stomach acid levels both add to the risk of heartburn by slowing digestion.
Adequate stomach acid levels are needed to prompt the lower esophageal sphincter (LES) to close properly. The LES is a ring of muscle at the base of the esophagus that closes to keep food in the stomach. When stomach acid levels are too low, the LES doesn’t close all the way allowing acid to reflux. This reflux of stomach acid irritates the esophagus giving us the pain we know of as heartburn.
In addition to the issue of reduced stomach acid, Helicobacter pylori infections can cause burping, bloating and vomiting.9 The burping and bloating both cause pressure on the LES allowing stomach acids to leak through into the esophagus. And vomiting irritates the esophagus exacerbating the overall problem making the esophagus more sensitive to the presence of acids.
At this point, a vicious cycle could occur. Antacids, H2 blockers, and proton pump inhibitors (PPIs) are taken to relieve that pain of heartburn, but the reduction in acids can allow these bacteria to thrive. The eradication of the Helicobacter pylori infection may be necessary to break this cycle.
A Helicobacter pylori infection can cause further GERD issues for those suffering from hypochlorhydria. A condition of chronically low stomach acid levels. Some theorize that Helicobacter pylori may be the cause of hypochlorhydria in many. Those with hypochlorhydria could stand to benefit from the eradication of this acid neutralizing bacteria.
Possible Inverse Connection of Helicobacter pylori and GERD
Some believe a Helicobacter pylori infection can benefit those with GERD. It lowers stomach acid levels reducing the irritation of GERD-related heartburn. However, lowering of stomach acid levels in any manner does not treat GERD. It only masks the symptoms of GERD by reducing the pain associated with heartburn. Lifestyle changes for most people will eliminate GERD and the need for acid reducers.
There may also be an argument of benefit for those who suffer from hyperacidity, a condition of excess acid production. The neutralization of stomach acids by Helicobacter pylori could be seen as a beneficial side effect.
It is speculated that any benefit would be outweighed by the negative effects of the bacteria, specifically the death rate associated with Helicobacter pylori associated gastric cancer. About 5.5% of all cancers are related to Helicobacter pylori and the bacteria accounts for 25% of all infection-associated cancers.10
How is Helicobacter Pylori Infection Diagnosed?
Although Helicobacter pylori can cause health complications, as many as 80% of those infected experience no symptoms or complications.1 To determine if you have a Helicobacter pylori infection, your doctor will review your symptoms, medications, and medical history and then perform a physical exam along with one or more of the following Helicobacter pylori tests.9,11
Helicobacter pylori breath test: In this test, urea is administered by mouth to check for the presence of Helicobacter pylori. The bacteria produces an enzyme called urease that converts urea into carbon dioxide. If the bacteria is present, increased carbon dioxide levels will be detected. For proper readings, antibiotics, bismuth medications, and PPIs should be discontinued for up to two weeks before the test.
The Helicobacter pylori breath test can be used as a follow-up test to see if the bacteria has been eliminated.
Helicobacter pylori blood test: This test for Helicobacter pylori measures the antibodies the body has produced to protect against the bacteria. This test can only determine if your body has Helicobacter pylori antibodies. It cannot tell if the infection is current or one from the past. Therefore, the Helicobacter pylori blood test can not be used as a follow-up test to see if the infection is eliminated.
Helicobacter pylori stool test: The Helicobacter pylori stool test checks for traces of the bacteria that are eliminated through the bowels. This test can also be used as a follow-up test to see if the bacteria has been eliminated.
Endoscopy/biopsy: An endoscopy is typically done if there is need to check for an ulcer, treat bleeding or to biopsy for possible cancer. An endoscope is a narrow tube, with an optical instrument and attachment for obtaining tissue samples called biopsies. The biopsy is checked for the presence of Helicobacter pylori and cancer.
Helicobacter Pylori Prevention
1) Maintain good health habits
Helicobacter pylori is often acquired during childhood and risk of infection increases with age due to potential exposure over time. Infection may come from food, water, utensils, or contact with bodily fluids of those infected.
The best forms of protection are to practice proper health habits:
- Wash hands regularly. Especially after using the bathroom and before eating or preparing food.
- Avoid unclean water. Helicobacter pylori is most common in communities lacking in clean water or proper sanitation services.
- Avoid unclean or improperly prepared food. Make sure food is fully cooked and that food preparers and servers have washed their hands.
2) Maintain proper acid levels
Research shows that Helicobacter pylori infection can only take place when stomach acid levels are not maintained at an optimal level. Over-the-counter antacid reducers my alleviate heartburn, but increase the risk for bacterial overgrowth by 50%.7
3) Don’t feed the bacteria
Helicobacter pylori and other unwanted bacteria feed on sugars, starches and grains. To prevent their proliferation, it is best to reduce the intake of these foods.
Helicobacter Pylori Treatment
If you have been diagnosed with Helicobacter pylori, medications are available to kill the bacteria and allow your body to heal. Your doctor will prescribe medications which may include two or more antibiotics, bismuth subsalicylate, and acid reducers. The antibiotics and bismuth subsalicylate will kill the bacteria. The acid reducers prescribed will be a PPI and possibly an H2 blocker. They help the antibiotics work more efficiently and lower acid irritation of the stomach lining to promote healing.9,11,12,13
In most cases, only one round of antibiotics lasting 1 to 2 weeks is needed to kill off the infection. Ulcers caused by the infection will likely heal after a few weeks. Your doctor may use the Helicobacter pylori breath test or the Helicobacter pylori stool test to verify that treatment has been successful.
Though the presence of Helicobacter pylori may relieve the heartburn symptoms of GERD in some. The negatives of the infection likely outweigh any benefit it might provide. You and your doctor should discuss testing and options if you are suspected of having this infection.
- U.S. Food and Drug Administration “Draft Guidance for Industry and FDA Staff – Establishing the Performance Characteristics of In Vitro Diagnostic Devices for the Detection of Helicobacter pylori”
- Centers for Disease Control and Prevention “Gastroenteritis and Transmission of Helicobacter pylori Infection in Households”
- National Cancer Institute “Helicobacter pylori and Cancer”
- US National Library of Medicine National Institutes of Health: World Journal of Gastroenterology “Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment”
- Influuent + UT Southwestern Medical Center “Symposium: Helicobacter pylori and clinical risks-focus on gastro-oesophageal reflux disease“
- US National Library of Medicine National Institutes of Health “Helicobacter Pylori and Gastroesophageal Reflux Disease”
- US National Library of Medicine National Institutes of Health “Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy.“
- US National Library of Medicine National Institutes of Health “Small Intestinal Bacterial Overgrowth“
- Johns Hopkins Medicine “Helicobacter Pylori“
- US National Library of Medicine National Institutes of Health “Helicobacter Pylori associated global gastric cancer burden“
- US National Library of Medicine: Medline Plus “Tests for H pylori”
- Mayo Foundation for Medical Education and Research “Diseases and Conditions – H. pylori infection: Treatments and drugs”
- Danish Medical Journal “Diagnosis and treatment of Helicobacter pylori infection“