Heartburn: Why You Need to be Tested for H. pylori

Do you suffer from or know someone who suffers from heartburn or acid reflux? Or worse, do you experience indigestion all the time?

If this is the case you may want to rethink turning to tums or just avoiding triggers (caffeine, tomatoes, chocolate, alcohol, spicy foods). These strategies will not get you better and you may actually have an infection in your stomach called Helicobacter Pylori. Symptoms of an H.Pylori infection include acid reflux, bloating, stomach pain, nausea, aversion to meat, stomach ulcers, and/or burping after eating.

Did you know H.pylori is the ONLY bacteria classified as a carcinogen because if left untreated it can progress to cancer and other issues like Barett’s esophagus and autoimmune conditions such as Hashimoto’s and Rheumatoid Arthritis? The scary part is according to the CDC 80% of gastric and duodenal ulcers are due to H.pylori. Worse yet, one study showed 46% of individuals who experience GERD (reflux) were H. pylori-infected.

The problem is though blood antibody testing for H. Pylori is typically only accurate during initial stages of infection completely missing those who are chronically infected (we will dive into why blood antibody testing for H. pylori is not accurate for chronic cases). The other issue with blood testing is not all strains of H pylori are “bad” or “pathogenic” meaning the potential to cause disease.

This is why I use the GIMAP stool test in my practice. It is highly sensitive and specific as well as shows virulence factors for H pylori (how likely is it to create disease). The GIMAP test also hows antibiotic resistance genes for H.pylori to provide insight into whether or not antibiotic therapy would be effective as well as which antibiotics would be the most effective.

How H. Pylori Creates Disease

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.

Once a person is infected, H. pylori burrow down into and attack the lining that protects your stomach. H.pylori also starts to make an enzyme called urease. This enzyme makes your stomach acids less acidic (neutralizes them by converting urea to ammonia). This weakens your stomach’s lining makes it more susceptible to being hurt by acid and pepsin that leads to ulcers in the stomach and small intestine.

So then why does someone still get heartburn if their stomach acid is being neutralized?

Since the stomach pH is not getting properly acidic, the stomach contents do not empty properly and the lower esophageal sphincter does not close to prevent reflux from the stomach to the esophagus. Retained food can be fermented by bacteria into lactic acid. The lactic acid produces the “burn” you feel (same as when you exercise). Proton pump inhibitors may produce symptom relief but as you can see they do not address the root cause and the risk (especially nutrient deficiencies) often outweighs the benefits.

If the stomach acid does not get to the proper acidity problems start to arise.

What are the symptoms that occur due to low stomach acid (hypochlorhydria) – due to H. pylori or as a result of PPI (Nexium) or H2 Receptor Blocker (Zantac) use?

  • Minerals like calcium, magnesium, iron, zinc, copper, selenium and boron are not absorbed as well. (Many are necessary for thyroid function, Magnesium cofactor for over 300 reactions, zinc 250, Minerals needed for bone health). If you have a chronic Iron deficiency and don’t know why – Look for gut infections.
  • Vitamins like B12 and folate are poorly absorbed (Important for energy and neurotransmitters)
  • Inability to digest and absorb protein – this means less building blocks for tissue repair
  • Gall Bladder issues: low stomach acid stimulates CCK and secretin to be released. CCK tells the gallbladder to squeeze and release bile to promote bowel motility. Secretin tells the liver to refill the gallbladder. Bile is necessary to breakdown and absorption of fats! This is key for hormone balance.
  • Less stomach acid increases the risk for SIBO or small intestinal bacterial overgrowth
  • bloating
  • burping
  • diarrhea
  • gas
  • hair loss
  • heartburn
  • intestinal infections (like worms & parasites)
  • nausea while taking supplements
  • nutrient deficiencies, including deficiencies in iron and vitamin B-12
  • undigested food in the stool
  • upset stomach
  • weak fingernails

There is also a link between hypochlorhydria and several other medical issues, such as:
* allergies
* anemia
* asthma
* autoimmune disorders
* skin problems, including acne and psoriasis

 

How is H. pylori diagnosed?

Your healthcare provider will look at your past health and give you a physical exam. He or she may also use other tests, including:

Blood tests. These check for infection-fighting cells (antibodies) which means you have the bacteria. Blood tests should only be used for initial stages and often miss chronic infections. This is because H pylori secretes a lipopolysaccharide called lewis antigens. These help the H. pylori “hide” from the immune system and divert the attack too often the parietal cells. Parietal cells of the stomach secrete hydrochloric acid and intrinsic factor. Intrinsic factor is necessary for absorbing B12. These Lipopolysaccharides also can alter the immune system potentially contributing to the development of autoimmunities such as type 1 diabetes and Hashimoto’s thyroiditis.

Stool culture. I personally run the GIMAP test. This looks for any abnormal bacteria in your digestive tract, normal bacteria, worms, parasites, digestive function, and more. A small stool sample is collected and sent to a lab. In 5-7 days, the test results will be back. You can order the GIMAP by booking an appointment at the Wild Side Wellness.

 

Breath tests. These can check if there is any carbon after you swallow a urea pill that has carbon molecules. If carbon is found that means that H. pylori has made the enzyme urease. This enzyme makes your stomach acids less acidic (neutralizes them). It weakens your stomach’s mucous lining.

Upper endoscopy, also called EGD (esophagogastroduodenoscopy). This test looks at the lining of your food pipe (esophagus), stomach, and duodenum (the first part of your small intestine). It uses a thin, lighted tube or endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes down into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. A small tissue sample (biopsy) is taken and the tissue sample can show if you have the enzyme urease. It can also check the bacteria that is there.

 

As you can see, simply taking tums or a PPI to “treat” acid reflux can set the stage for significant health complications. Since a significant amount of heartburn has been related to H. pylori, this absolutely needs to be investigated. Please continue to ask “WHY” a symptom is occurring instead of taking a pill for every ill. The rest of the body is going to pay the price if the infection goes untreated.

 

PS did you know ranitidine (Zantac) has been recalled please talk to your doctor if you are on this medication. In addition, READ YOUR MEDICATION INSERTS! Ranitidine specifically says “Do not take over-the-counter ranitidine for longer than 2 weeks” – Nexium reads “NEXIUM is indicated for the short-term treatment (4 to 8 weeks) “ – IF YOU ARE ON THESE MEDICATIONS LONGER YOU NEED TO ASK WHY! “Proton pump inhibitor treatment should only be initiated and continued if the benefits outweigh the risks of treatment”.

 

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216628/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270508/
http://www.hindawi.com/journals/jir/2015/981328/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831148/
http://www.ncbi.nlm.nih.gov/pubmed/22029731
https://www.uspharmacist.com/article/proton-pump-inhibitors-considerations-with-longterm-use
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022101s014021957s017021153s050lbl.pdf
http://www.ncbi.nlm.nih.gov/pubmed/24142637
http://www.biomed.cas.cz/physiolres/pdf/57%20Suppl%201/57_S135.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695884/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539101/

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