The stomach maintains a continuous mucous lining, or biofilm, that coats the stomach for its protection because, after all, it is bathed in a highly acidic mixture produced by the parietal cells of the stomach lining. Into this delicate balance, however, enters a common microorganism that first infected humans around the time that primitive humans first migrated out of Africa, but somehow became very common somewhere around the advent of the industrial age: Helicobacter pylori, or H. pylori.
H. pylori has an interesting history in the medical world. For centuries, gastritis, heartburn, and stomach and duodenal ulcers were viewed as the product of stress, consuming too many acidic foods, and myriad other explanations, often treated with advice to avoid vinegar, tomato sauce, other acidic foods and drink more milk. Then two Australian researchers, Barry Marshall and Robin Warren, identified H. pylori in the base of human stomach and duodenal ulcers and published their observations in 1984, throwing the entire gastroenterology world topsy-turvy. It explained why people treated with only stomach acid-suppressing drugs frequently experienced relapse. Unfortunately, Marshall and Warren were summarily ridiculed, ostracized from medical circles (even prompting Marshall to infect himself with H. pylori then have biopsy-proven gastritis develop). Subsequent work, however, proved them right, earning them a Nobel Prize for Medicine 20 years later in 2005 . It is now clear that stomach and duodenal ulcers that are not caused by aspirin or anti-inflammatory drugs such as naproxen or ibuprofen are nearly all caused by H. pylori.
It has since become clear that H. pylori is oddly ubiquitous, essentially a parasite that can be found in about 15-35% of Americans (variation due to age, geography, and other factors), 50% of people around the world, with increasing likelihood of infection as we age. While originally identified as the cause for ulcers, then gastric cancer, it has become clear that H. pylori is responsible for a lot more, including alterations in bowel flora composition.
Among the health conditions that have been associated with H. pylori are:
- Increased stomach acid (hyperchlorhydria)—Particularly in younger people in which H. pylori infects the antrum of the stomach (towards the duodenum). This explains why acid reflux, reflux esophagitis, and ulcers respond to stomach acid-blocking drugs, the H2 blockers and PPIs, and why 80-95% of people positive for H. pylori develop stomach or duodenal ulcers. In later phases, hypo- or achlorhydria, i.e., low or absent stomach acid, can develop, the situation that sets the stage for stomach cancer. (The World Health Organization has classified H. pylori as a class I carcinogen.) Note that acid-blocking drugs can also provide relief from acid reflux and esophagitis, conditions separate from H. pylori-based issues.
- Increased gastrin hormone levels—If hypo- or achlorhydria develop from H. pylori, increased gastrin hormone secretion in response to the lack of stomach acid can, over time, lead to stomach cancer, as gastrin provokes proliferation of stomach lining and acid-producing parietal cells. Stomach cancer is the third most common form of cancer worldwide with H. pylori as the leading cause.
- Skin rashes—A variety of skin rashes have been associated with H. pylori, but persistent psoriasis and rosacea are among the most common. In the case of rosacea, eradication of H. pylori is more effective in reversing the rash than modern rosacea treatments.
- Coronary disease—Especially virulent varieties of H. pylori (that express the CagA toxin) are more likely to be found in people who develop heart disease. (This is, however, an observational connection and not clear whether it is cause-effect.)
- Idiopathic thrombocytopenic purpura (ITP)—An uncommon condition in which blood platelet counts dip dangerously low and bruising and hemorrhage can occur.
- Autoimmune conditions—The list of autoimmune conditions that accompany H pylori and recede with its eradication continue to grow and includes ITP, Sjogren’s syndrome, Henoch-Schlonlein purpura, some forms of autoimmune nephropathy (kidney disease) and peripheral neuropathies.
- A variety of lung diseases–-Such as chronic bronchitis and other conditions.
- Parkinson’s disease—People with Parkinsonism have greater likelihood of having H. pylori with improvement in Parkinson’s symptoms with eradication.
- Small intestinal bacterial overgrowth (SIBO)—may occur along with H. pylori in as many as 50% of people diagnosed with either.
- Fatty liver, insulin resistance, inflammation—This combination of abnormalities improve with H. pylori eradication.
- Deficiencies of vitamin B12, vitamin D, and iron
- Increased potential for other cancers that include lung, liver, biliary, and pancreatic. (However, once again the evidence is observational.)
In other words, H. pylori is not just about stomach and duodenal ulcers, but has wide implications for health across many health conditions.
If you have H. pylori or suspect you do, there are easy ways to identify/verify its presence, tests you can even conduct easily and inexpensively without your doctor in the comfort of your own home. Even further, there are strategies you can follow that are as effective or more effective than conventional 3- or 4-antibiotic regimens typically used to eradicate this microorganisms, natural remedies that you can purchase on your own. You can find this more extended conversation in the Undoctored Inner Circle in the Advanced Topic: A Primer on Stomach Acid and H. pylori.