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Helicobacter and Stomach Ulcers

If you belch or have burning in your stomach or chest, particularly when your stomach is empty, you probably have either an infection, a tumor, or a condition called GERD (reflux or regurgitation). Infection with bacteria such as helicobacter pylori is by far the most common cause.

Your doctor will probably order an upper GI series X ray to rule out a tumor. That almost always comes back negative to tell you that you do not have tumor. Then you get a blood test for bacteria called Helicobacter pylori and you should be treated with antibiotics even if the blood test is negative, because there are at least 23 other species of bacteria that this test does not detect. Your gastroenterologist will want to put a tube down your mouth and into your stomach, but the biopsy that he will do to find the Helicobacter can often miss the germ even when it is there (11). If your doctor does not offer the antibiotic treatment (see below), you will be stuck with a diagnosis of regurgitation, called GERD, which means you have pain and no one can tell you why. You will need to take medication for the rest of your life.

An article in the medical journal GUT reported that at least 24 different bacteria have been shown to cause stomach ulcers (16). Since doctors do not have any way to check for all 24 different bacteria (10), all people with belching and burning in the stomach should be given a one-week course of antibiotics that are used to treat the most common cause of stomach ulcers, called Helicobacter Pylori.

Twenty years ago, stomach ulcers were treated by drinking cream. Today, almost everyone with belching and burning in the stomach should be treated with antibiotics. In 1983 they laughed at Dr. Barry Marshall when he reported that stomach ulcers were caused by infection with helicobacter pylori and could be cured with antibiotics. Fellow physicians were so mean to him that he responded by swallowing a vial of helicobacter and almost died. He recently received the Nobel Prize for his pioneering work.

Now almost every reasonable physician agrees that all people who have belching and burning in the stomach and a positive blood test for helicobacter pylori can be cured with antibiotics, but many gastroenterologists stubbornly refuse to treat patients with ulcer symptoms and a negative blood test or biopsy for that germ. They are clearly wrong because literature shows that at least 24 germs cause an irritation in the stomach (9), including H. helmannii (13), H. felis, H. rappini, H. cinaedi, H sp. Strain Mainz (14) H. fennelliae and H. pullorum, H. hepaticus, H. Billis, H. canis, H. Hills (15), cytomegalovirus and mycoplasma (1,2,3,4,5,6,7,), and Helicobacter mesocricetorum sp nov (12).

Helicobacter species have been isolated from the stomachs of dogs, cats, ferrets, pigs, monkeys and cheetahs, birds, mice, chickens. The standard treatment of one week of clarithromycin 500 mg twice a day, metronidazole 500 mg twice a day and omeperazole 20 mg once a day is safe and effective. These germs also grow in saliva, so they can be transmitted between family members and pets. So some doctors prescribe antibiotics to all people with belching and stomach burning, and check the other members of the household for symptoms.

At least 12 weeks later, you need a follow up blood test for helicobacter. If your symptoms are gone and the titre drops, you are probably cured. If your helicobacter titre is still high, your helicobacter is probably resistant to metronidazole and you need to be treated for at least ten days with amoxacillin 500 mg four times a day, tetracycline 500 mg three times a day and omeperazole 20 mg once a day (1). If you still have symptoms, you may need to have a tube put down your throat by a gastroenterologist. If you have regurgitation of stomach acid into your esophagus (reflux, hiatal hernia), you may need to be treated with 20 mg omeperazole once a day. Some people who are not infected with helicobacter may benefit from taking clarithromycin or other antibiotic for a longer period of time.

Helicobacter may also cause liver disease, blood vessel diseases such as clotting and heart attacks, and certain skin conditions such as rosacea.

1)JG Kusters, EJ Kuipers. Non-pylori Helicobacter infections in humans. European Journal of Gastroenterology & Hepatology. 10: 3 (MAR 1998):239-241.

2) JC Debongnie, M Donnay, J Mairesse, V Lamy, X Dekoninck, B Ramdani. Gastric ulcers and Helicobacter heilmannii. European Journal of Gastroenterology & Hepatology. 10: 3 (MAR 1998):251-254.

3) MA Stone, DB Barnett, JF Mayberry. Lack of correlation between self-reported symptoms of dyspepsia and infection with Helicobacter pylori, in a general population sample. European Journal of Gastroenterology & Hepatology. 10: 4 (1998):301-304.

4) 1) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

5) MJ Blaser. Heterogeneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.

6) C Seidl,V Grouls,HJ Schalk. Bulboduodenitis associated with Helicobacter heilmannii (formerly Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.

7) H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.

8) J Fox. Helicobacters: the next generation. Baillieres Clinical Infectious Diseases 4: 3(NOV 1997):449-471.

9)A Meining, G Kroher, M Stolte. Animal reservoirs in the transmission of Helicobacter heilmannii - Results of a questionnaire-based study. Scandinavian Journal of Gastroenterology 33: 8(AUG 1998):795-798. dogs, chickens cats, cattle, or pigs reservoirs in the transmission of H. heilmannii. J Fox. Helicobacters: the next generation. Baillieres Clinical Infectious Diseases 4: 3(NOV 1997):449-471. dogs, cats, ferrets, pigs, monkeys and cheetahs, other mammals, and birds. mice H. canis, H. rappini and H. pullorum isol To date, there are at least 19 formally named species of the new genus, Helicobacter.

10) Monkeys have so many different bacteria in their stomachs that nobody can tell what belongs there or is causing stomach symptoms . The bacteria that were found were susceptible to the following antibiotics: amikacin, ciprofloxacin, gentamicin, cefoperazone, tobramycin, imipenem, and trimethoprim/ sulfamethoxazole. SS KhanolkarGaitonde, GK Reubish, CK Lee, CTKH Stadtlander. Isolation of bacteria other than Helicobacter pylori from stomachs of squirrel monkeys (Saimiri spp.) with gastritis. Digestive Diseases and Sciences, 2000, Vol 45, Iss 2, pp 272-280.

11) R Colin, P Czernichow, V Baty, I Touze, F Brazier, JF Bretagne, I Berkelmans, P Barthelemy, J Hemet. Low sensitivity of invasive tests for the detection of Helicobacter pylori infection in patients with bleeding ulcer. Gastroenterologie Clinique et Biologique, 2000, Vol 24, Iss 1, pp 31-35.

12)Helicobacter mesocricetorum sp nov., a novel helicobacter isolated from the feces of Syrian hamsters. Journal of Clinical Microbiology, 2000, Vol 38, Iss 5, pp 1811-1817.

13) K Mention, L Michaud, D Guimber, EM DeLasalle, P Vincent, D Turck, F Gottrand. Characteristics and prevalence of Helicobacter heilmannii infection in children undergoing upper gastrointestinal endoscopy. Journal of Pediatric Gastroenterology and Nutrition, 1999, Vol 29, Iss 5, pp 533-539.

14) P Vandamme, CS Harrington, K Jalava, SLW On. Misidentifying helicobacters: the Helicobacter cinaedi example. Journal of Clinical Microbiology, 2000, Vol 38, Iss 6, pp 2261-2266.

15) P Ferenci. The importance of Helicobacter - Also beyond the stomach. Acta Medica Austriaca, 2000, Vol 27, Iss 4, pp 109-111.

16) The non-H pylori helicobacters: their expanding role in gastrointestinal and systemic diseases. Gut, 2002, Vol 50, Iss 2, pp 273-283. JG Fox. MIT, Div Comparat Med, 77 Massachusetts Ave, Bldg 16, Room 825C, Cambridge,MA 02139 USA

17)Highly effective second-line anti-Helicobacter pylori therapy in patients with previously failed metronidazole-based therapy. Scandinavian Journal of Gastroenterology 32:12(Dec 1997):1209-1214.

18) NA Alsomal, KE Coley, PC Molan, BM Hancock. Role of Helicobacter Pylori Serology in Evaluating Treatment Success. Digestive Diseases and Sciences 1993 (Dec);38(12): 2262-2266.

19) WM Wang, CY Chen, CM Jan, LT Chen, DS Perng, SR Lin, CS Liu. Long term follow up and serological study after triple therapy of Helicobacter pylori associated duodenal ulcer. American Journal of Gastroenterology 89: 10(OCT 1994):1793-1796.

20)MA Mendall, RP Jazrawi, JM Marrero, N Molineaux, J Levi, JD Maxwell, TC Northfield. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut 36:3 (MAR 1995):330-333.

21) Z Maratka. Endoscopic diagnosis of gastritis: Pros and Cons. Journal of Clinical Gastroenterology 20:2(MAR 1995):92-93. The endoscopic characteristics of inflammation in the stomach, in contrast to those of the esophagus and colon, are inconspicuous or lacking, ''Endoscopic gastritis'' does not correlate sufficiently with ''histologic gastritis'' and the term ''gastritis'' is to be limited to cases confirmed histologically.

22) CA Fallone, GE Wild, CA Goresky, AN Barkun. Evaluation of IgA and IgG serology for the detection of Helicobacter pylori infection. Canadian Journal of Gastroenterology 9: 2(MAR-APR 1995):105-111.

23) TU Kosunen. Antibody titres in Helicobacter pylori infection: Implications in the follow-up of antimicrobial therapy. Annals of Medicine 27: 5 (OCT 1995):605-607. Success in eradication is reflected in 40-50% decrease of antibody titres within 5-6 months. The decrease continues and most patients have normal titres within 2 years.

24) RJF Laheij, JBMJ Jansen, EH Vandelisdonk, ALM Verbeek. Review article: Symptom improvement through eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Alimentary Pharmacology & Therapeutics 10: 6(DEC 1996):843-850. 8)M Feldman, B Cryer, E Lee, WL Peterson. Role of seroconversion in confirming cure of Helicobacter pylori infection. JAMA, 280:4(JUL 22 1998):363-365

25) MA Asante, M Mendall, P Patel, L Ballam, TC Northfield. A randomized trial of endoscopy vs no endoscopy in the management of seronegative Helicobacter pylori dyspepsia. European Journal of Gastroenterology & Hepatology. 10: 12 (DEC 1998):983-989.

26) McCarthy, C et al. Digestive Diseases and Sciences 1995;40:114-119.

27) Kuipers EJ at al. Atrophic gastritis and helicobacter pylori infection in patients with reflux esophagitis treated with omeperazole or fundoplication. NEJM, 1996(April 18);334(16):1018-1022.

28) C Omorain, M Buckley. Helicobacter pylori and dyspepsia. Scandinavian Journal of Gastroenterology. 31: Suppl. 214 (1996):28-30. 6778 4/7/96

29) BS Sheu, CY Lin, ZX Lin, SC Shiesh, HB Yang, CY Chen. Long-term outcome of triple therapy in Helicobacter pylori-related nonulcer dyspepsia: A prospective controlled assessment. American Journal of Gastroenterology 91: 3 (MAR 1996):441-447. Compared with control therapy at 1 yr, triple therapy showed greater symptomatic, serological, and histological improvements. Therefore, triple therapy is beneficial to symptomatic HP-related NUD.

30) S Khulusi, S Badve, P Patel, R Lloyd, JM Marrero, C Finlayson, MA Mendall, TC Northfield. Pathogenesis of gastric metaplasia of the human duodenum: Role of Helicobacter pylori, gastric acid, and ulceration. Gastroenterology 110: 2 (FEB 1996):452-458. This study shows that the extent of duodenal GM is unrelated to the presence or absence of ulceration but is partly due to H. pylori and partly due to acid.

31) Annals of Internal Medicine August 15, 1995;123:260-268.

32) BJ Marshall. Managing acid peptic disease in the Helicobacter pylori era. Journal of Clinical Gastroenterology 21: Suppl. 1(1995):S155-S159. The advent of new diagnostic and therapeutic modalities for Helicobacter pylori allows any physician to offer curative antibiotic regimens to patients with peptic ulcer disease and gastritis. In the new strategy, patients with dyspepsia are investigated with serology to detect those with H. pylori and potentially curable peptic ulcers. Only those who are H. pylori-negative undergo endoscopy.

33)AF Cutler, VM Prasad. Long-term follow-up of Helicobacter pylori serology after successful eradication. American Journal of Gastroenterology 91: 1 (JAN 1996):85-88. A 20% decline in IgG concentration has an overall sensitivity of 93 % for determining H. pylori eradication 12-21 months after H. pylori treatment.

34) M Buckley, C Omorain. Prevalence of Helicobacter pylori in non-ulcer dyspepsia. Alimentary Pharmacology & Therapeutics 9: Suppl. 2(1995):53-58.

35) AF Cutler, VM Prasad. Long-term follow-up of Helicobacter pylori serology after successful eradication. American Journal of Gastroenterology 91: 1 (JAN 1996):85-88. A 20% decline in IgG concentration has an overall sensitivity of 93 % for determining H. pylori eradication 12-21 months after H. pylori treatment.

36) PA Testoni, E Colombo, L Cattani, M Longhi, F Bagnolo, F Lella, M Buizza, R Scelsi. Helicobacter pylori serology in chronic gastritis with antral atrophy and negative histology for Helicobacter-like organisms. Journal of Clinical Gastroenterology 22: 3 (APR 1996):182-185.

37) M Plebani, D Basso, M Cassaro, L Brigato, M Scrigner, A Toma, F Dimario, M Rugge. Helicobacter pylori serology in patients with chronic gastritis. American Journal of Gastroenterology 91: 5 (MAY 1996):954-958. Helicobacter pylori (Hp) serum IgG and Pepsinogen most accurately indicated Hp infection, and their product mag he proposed as an aid in diagnosing Hp infection in dyspeptic patients.

38)H Kawaguchi, K Haruma, K Komoto, M Yoshihara, K Sumii, G Kajiyama. Helicobacter pylori infection is the major risk factor for atrophic gastritis. American Journal of Gastroenterology 91: 5 (MAY 1996):959-962. 14)J Labenz, T Rokkas. Helicobacter pylori and dyspepsia. Current Opinion in Gastroenterology 13: Suppl. 1(1997):A Heaney, JSA Collins, RGP Watson, RJ McFarland, KB Bamford, TCK Tham.A prospective randomised trial of a ''test and treat'' policy versus endoscopy based management in young Helicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic.Gut, 1999, Vol 45, Iss 2, pp 186-190.

39) S Tefera, JG Hatlebakk, A Berstad.The effect of Helicobacter pylori eradication on gastro-oesophageal reflux. Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 915-920.Twelve weeks after H. Pylori eradication there was no consistent change in gastro-oesophageal acid reflux in patients with mild or moderate reflux oesophagitis.

40)FTM Peters, EJ Kuipers, S Ganesh, WJ Sluiter, EC KlinkenbergKnol, CBHW Lamers, JH Kleibeuker.The influence of Helicobacter pylori on oesophageal acid exposure in GERD during acid suppressive therapy.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 921-926.

41) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

42) C Dieterich, P Wiesel, R Neiger, A Blum, I Corthesytheulaz. Presence of multiple ''Helicobacter heilmannii'' strains in an individual suffering from ulcers and in his two cats. Journal of Clinical Microbiology 36: 5 (MAY 1998):1366-1370.

43) M Giladi, A Lembo, BL Johnson. Postural epigastric pain: A unique symptom of primary cytomegalovirus gastritis? Infection 26: 4 (JUL-AUG 1998):234-235.

44) RJ Owen. Helicobacter - species classification and identification. British Medical Bulletin 54: 1 (1998):17-30.

45) N Kitamoto, H Nakamoto, A Katai, N Takahara, H Nakata, H Tamaki, T Tanaka. Heterogeneity of protein profiles of Helicobacter pylori isolated from individual patients. Helicobacter 3: 3 (SEP 1998):152-162.

46) CF Li, TZ Ha, DA Ferguson, DS Chi, RG Zhao, NR Patel, G Krishnaswamy, E Thomas. A newly developed PCR assay of H-pylori in gastric biopsy, saliva, and feces: Evidence of high prevalence of H-pylori in saliva supports oral transmission. Digestive Diseases and Sciences 41: 11 (NOV 1996):2142-2149.

47) K Schutze, E Hentschel, B Dragosics, AM Hirschl. Helicobacter pylori reinfection with identical organisms: Transmission by the patients' spouses. Gut 36: 6 (JUN 1995):831-833.

48) Infection and Immunity 1994;62:2367-74.

49) K Shankaran, HG Desai. Helicobacter pylori in dental plaque. Journal of Clinical Gastroenterology 21:2(SEP 1995):82-84.

50) F Parente, G Maconi, O Sangaletti, M Minguzzi, L Vago, E Rossi, GB Porro. Prevalence of Helicobacter pylori infection and related gastroduodenal lesions in spouses of Helicobacter pylori positive patients with duodenal ulcer. Gut 39: 5 (NOV 1996):629-633.

51) SD Georgopoulos, AF Mentis, CA Spiliadis, LS Tzouvelekis, E Tzelepi, A Moshopoulos, N Skandalis. Helicobacter pylori infection in spouses of patients with duodenal ulcers and comparison of ribosomal RNA gene patterns. Gut 39: 5 (NOV 1996):634-638.

52) C Dieterich, P Wiesel, R Neiger, A Blum, I Corthesytheulaz. Presence of multiple ''Helicobacter heilmannii'' strains in an individual suffering from ulcers and in his two cats. Journal of Clinical Microbiology 36: 5 (MAY 1998):1366-1370.

53)Meining, G Kroher, M Stolte. Animal reservoirs in the transmission of Helicobacter heilmannii - Results of a questionnaire-based study. Scandinavian Journal of Gastroenterology 33: 8(AUG 1998):795-798.

54) N Chiba, ABR Thomson, P Sinclair. From bench to bedside to bug: An update of clinically relevant advances in the care of persons with Helicobacter pylori-associated diseases. Canadian Journal of Gastroenterology, 2000, Vol 14, Iss 3, pp 188-198.

55) NEJM, July 25, 1996

60) R Barretozuniga,M Maruyama,Y Kato, K Aizu, H Ohta, T Takekoshi, SF Bernal.Significance of Helicobacter pylori infection as a risk factor in gastric cancer:Serological and histological studies. Journal of Gastroenterology 32: 3 (JUN 1997):289-294.

56)JH Siman,A Forsgren,G Berglund,CH Floren.Association between Helicobacter pylori and gastric carcinoma in the city of Malmo, Sweden-A prospective study. Scandinavian Journal of Gastroenterology 32: 12(DEC 1997):1215-1221.

57) E Ierardi, R Francavilla, C Panella. Effect of Helicobacter pylori eradication on intestinal metaplasia and gastric epithelium proliferation. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):470-475.

58) S Tsuji, M Tsujii, WH Sun, ES Gunawan, H Murata, S Kawano, M Hori. Helicobacter pylori and gastric carcinogenesis. Journal of Clinical Gastroenterology. 25: Suppl. 1(1997):S186-S197.

59) R Cheli, M Crespi, G Testino, F Citarda. Gastric cancer and Helicobacter pylori: Biologic and epidemiologic inconsistencies. Journal of Clinical Gastroenterology 26: 1 (JAN 1998):3-6.

60) V Pasceri, G Cammarota, G Patti, L Cuoco, A Gasbarrini, RL Grillo, G Fedeli, G Gasbarrini, A Maseri. Association of virulent Helicobacter pylori strains with ischemic heart disease. Circulation 97: 17 (MAY 5 1998):1675-1679.48-51. J Danesh. Helicobacter pylori infection and gastric cancer: systemic review of the epidemiological studies.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 851-856.

61) K Haruma, K Komoto, T Kamada, M Ito, Y Kitadai, M Yoshihara, K Sumii, G Kajiyama. Helicobacter pylori infection is a major risk factor for gastric carcinoma in young patients. Scandinavian Journal of Gastroenterology, 2000, Vol 35, Iss 3, pp 255-259.

62) JW Konturek, A Dembinski, SJ Konturek, J Stachura,W Domschke. Infection of Helicobacter pylori in gastric adaptation to continued administration of aspirin in humans. Gastroenterology 114: 2 (FEB 1998):245-255.

63) RI Russell. Helicobacter pylori eradication may reduce the risk of gastroduodenal lesions in chronic NSAID users. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):465-469.

64) CY Wu, SK Poon, GH Chen. Is Helicobacter pylori a risk factor for NSAID- associated gastric ulcer bleeding? A sex- and age-matched case-control study. Advances in Therapy 15: 2 (MAR-APR 1998):85-91.

65) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

66) MJ Blaser. Hetero- geneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.

67) C Seidl,V Grouls,HJ Schalk.Bulboduodenitis associated with Helicobacter heilmannii (formerly Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.

68) H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.

69) D Scott, D Weeks, K Melchers, G Sachs. The life and death of Helicobacter pylori. Gut 43: Suppl. 1 (JUL 1998):S56-S60. In the absence of division, antibiotics such as clarithromycin and amoxycillin are ineffective. Proton pump inhibitors, by elevating gastric pH, would increase the population of dividing organisms and hence synergise with these antibiotics.

Checked 4/16/14

January 1st, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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