<p>In another one of those cases where it turns out you may be carrying something you never previously knew about, around half of the world’s population is infected with<em> Helicobacter pylori</em>. Your risk of catching it increases with age, and it’s especially prevalent in Asia, Africa, and Eastern Europe.</p> <p><em>H. pylori</em> are a type of bacteria that infects the lining of your stomach. Several gastric disorders are linked to it, with one of the most prominent being peptic ulcers. These ulcers tend to produce a nasty burning sensation between the breastbone and the belly button that feels like your stomach is eating itself from the inside out. Pain, indigestion, and bloating can follow. </p> <p><em>H. pylori</em> is thought to be behind 85%–95% of peptic ulcers in developing countries and 30%–50% in the developed world. Around 10%–20% of infected people go on to develop a peptic ulcer from it.</p> <p>While experts aren’t sure why, most infected people have <em>H. pylori</em> kicking about for years without realizing it. What we do know is that these bacteria have some remarkable quality that allows them to survive and colonize for decades in the dangerously acidic environment of the human stomach. With aging and time, this activity can lead to progressive inflammatory and ulcer-causing effects.</p> <figure><img alt="" src="https://cdn.storymd.com/optimized/Nq46mZT7oK/thumbnail.jpg" /> <figcaption>Stomach Ulcer. <em>Souce: BruceBlaus/Wikimedia</em></figcaption> </figure> <h2>Antibiotics are an unsustainable solution</h2> <p>The standard way of treating peptic ulcers caused by bacterial infection is to use triple therapy. By combining two different types of antibiotics with proton pump inhibitors, most patients can eradicate the disease in 14 days of treatment.</p> <p>But there’s a problem. Completely eradicating the bacteria is needed because leaving scraps behind gives them the chance to return and reinfect, and triple therapy is waning in its potency. Just like elsewhere, antibiotics overuse is leading to the development of new bacterial strains that are resistant to these medicines. </p> <p>In the context of treating <em>H. pylori</em> infections, the drop in antibiotics performance is pretty significant — there are reports of efficacy rates now dipping below the 80% mark. </p> <p>Some patients struggle with gastrointestinal side effects from the medication too: abdominal pain, diarrhea, constipation, and “metallic taste” are common in the literature. These complications can be so bad that some patients are unable to make it through the full course of their medication, so the bacteria end up surviving the assault. </p> <p>These drawbacks are pressuring the medical world to find an alternative that’s more sustainable than firing off the old standard with diminishing returns. </p> <h2>Killing two microbial birds with one stone</h2> <p>Probiotics are easily one of the biggest health trends of the past decade, and they’ve steadily seen more attention in the gastrointestinal world. </p> <p>They’re live cultures of microorganisms that promote microbial balance in the intestine and bring about positive health effects for the host, e.g., improving digestion and intestinal flora balance, boosting immunity and resistance to infection, and inhibiting the growth of dangerous bacteria.</p> <p>Researchers are warming to the idea that probiotics, when used in tandem with antibiotics or on their own, may enhance the eradication of <em>H. pylori </em>as well as cushion side effects during therapy. </p> <p>Antibiotics can mess with the balance of flora in bacteria and lead to diarrhea, but probiotics may be able to reverse this. Certain strains have also been noted to have anti-inflammatory properties that deflate gastritis, as well as antioxidant effects that can soothe damage to the stomach lining. </p> <h2>Putting the "pro" in probiotics</h2> <p>A great deal of research has gone into exploring probiotics as a solution for <em>H. pylori </em>infections. </p> <p>A 2017 systematic review looked at some 140 papers involving 20,215 patients and over 10 different kinds of probiotic strains, including <em>Lactobacillus</em> and <em>Bifidobacterium</em>, both of whom have known anti-inflammatory properties.</p> <p>Supplementary probiotics were found to be generally effective at improving the eradication of <em>H. pylori,</em> as well as lowering the incidence of side effects. Some 84% of participants who used probiotics achieved full eradication, while only 70% of those using antibiotics alone achieved the same.</p> <p>Another meta-analysis involving close to 9,000 participants over 40 papers highlighted <em>Lactobacillus </em>as a superior strain, with a stronger antibacterial effect and a possible boost to cellular immunity. Interestingly, the eradication rate was better among Chinese populations.</p> <p><em>Lactobacillus </em>was previously shown to be effective at healing stomach ulcers in rats, and one of the subtypes has demonstrated an ability to promote the regeneration of epithelial cells, which are needed to repair the lining of the stomach wall.</p> <p>As for <em>Bifidobacterium</em>, Spanish scientists highlighted a particular strain (bifidum CECT 7366) that could be superior to antibiotics at treating <em>H. pylori</em>-derived stomach ulcers. After isolating several strains from the feces of breast-fed children and narrowing it down, the winning strain was found to be 95% effective in in vitro conditions. Further testing on mice elicited “significantly fewer” stomach ulcers when treated with the bifidum CECT 7366 strain.</p> <h2>What's happening under the hood?</h2> <p>In terms of the mechanism of action, both non-immunological and immunological effects have been touted. A 2016 paper reported that probiotics stimulate the production of antimicrobials and antioxidants that inhibit either the growth or the activity of <em>H. pylori. </em></p> <p>Next, probiotics play a defensive role by interrupting the bacteria as they try to bind to the surface of gastric epithelial cells, and they also support the mucosal barrier (a protective layer) on the surface of the cells.</p> <figure><img alt="" src="https://cdn.storymd.com/optimized/2dZePZujoG/thumbnail.jpg" /> <figcaption>Ulcer-Causing Bacterium (H.Pylori) Crossing Mucus Layer of Stomach. <em>Source: Zina Deretsky, National Science Foundation</em></figcaption> </figure> <p>Immunologically, probiotics appear to offer a balancing effect between pro- and anti-inflammatory cytokines, aiding in the recovery of gastritis. Probiotics reportedly downregulate the production of inflammatory cytokines like IL-8 and TNF-α through the production of linoleic acid, and they upregulate anti-inflammatory suppressors of cytokines by activating certain transcription factors (STAT-1 and STAT-3).</p> <p>“With accumulating evidence supporting the benefits of using probiotics as an adjunct to standard therapy, the management of <em>H. pylori</em> infections is on the verge of undergoing a much-needed revolutionary change,” concluded MD Suresh Ade in an editorial piece for Medical Dialogues. </p> <h2>More on Stomach Ulcers and Probiotics</h2><ul><li><a href="https://soulivity.storymd.com/journal/9jkppzrtbm-stomach-ulcer" target="_blank">Peptic Ulcers (Stomach Ulcers): Causes, Symptoms, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/qj358nbtam-helicobacter-pylori-infections" target="_blank">Helicobacter Pylori Infections</a></li><li><a href="https://soulivity.storymd.com/journal/wepd7ak05j-probiotics" target="_blank">The Health Benefits of Probiotics and How to Add Them to Your Diet</a></li></ul>