Abstract
Helicobacter pylori overgrowth in the gastrointestinal tract is a contributor to the formation of gastric ulcers, gastric cancer, and a unique lymphoma involving the gut mucosa (mucosal-associated lymphatic tissue lymphoma). Extragastric conditions, such as rashes, joint pain, and autoimmune thrombocytopenia have also been linked to H pylori overgrowth. Current treatments to eradicate H pylori include antibiotics, which bring some risk of untoward effects. Natural agents such as bismuth, mastic gum, and oil of oregano may achieve the therapeutic goal of eradication without undue risks. Our clinic undertook a chart review of patients who had elected to try this trio of natural agents for H pylori overgrowth. The results indicate this combination is a feasible strategy for many patients who elect not to take antibiotics.
Introduction
Helicobacter pylori is a common occupant of the human gastrointestinal tract. Worldwide, it is estimated that up to half the population is infected, with more than three-quarters affected in many endemic areas, especially in developing countries.1 It is also established that H pylori is a primary cause of gastric ulcers, and longstanding infection can lead to noncardia gastric cancer.2 Still, fewer than 20% of those infected develop ulcers, and fewer than 2% develop stomach cancer.3 Paradoxically, some strains of H pylori may protect people from developing gastric cancer arising in the cardia of the stomach while increasing the likelihood of cancer of the body or antrum of the stomach.1 In addition to digestive disorders, an increasing number of extraintestinal health problems and organ dysfunction are recognized as associated with H pylori infection. These include a variety of skin rashes and joint problems,4 blood disorders (eg, autoimmune thrombocytopenia),5 eye inflammation (uveitis),6 and other autoimmune disorders.7,8
Reinfection after antibiotic therapy is possible, although not common.9 Repeated courses of antibiotics, especially the combination antibiotics required for standard H pylori therapy, have an increasing potential for harm because each antibiotic has its unique potential for side effects. Antibiotic therapy also impacts the gut microbiota by increasing the prevalence of antibiotic-resistant bacteria and yeast infection. Furthermore, there is general consensus that reduction of antibiotic usage is an essential measure to combat the increasing rates of antibiotic-resistant bacterial infections around the world.10
Overall, nonprescription therapy gives patients and physicians another option when faced with H pylori infection, and it has the benefit of helping to promote the balance of intestinal flora while having potentially fewer side effects than antibiotics.
There are several natural agents that are good candidates for eradication of H pylori overgrowth. With this in mind, we have used a combination of bismuth, oil of oregano, and mastic gum. These agents were selected for inclusion in the protocol based on previous studies suggesting effectiveness against H pylori.
Bismuth is already part of US Centers of Disease Control and Prevention‒approved regimens, either as Pepto-Bismol (Procter & Gamble Co, Cincinnati, Ohio) combined with metronidazole, tetracycline, and an H2-receptor antagonist or as ranitidine bismuth citrate combined with clarithromycin.11 Oil of oregano was included because of evidence of in vitro effectiveness.12 Mastic gum has been used traditionally in Greece and Turkey as a remedy for gastric symptoms, and research has shown its antimicrobial activity against H pylori.13,14
Methods
Between November 2008 and November 2013, we analyzed 1209 patients’ stool samples using DNA probe polymerase chain reaction (PCR) technique to detect H pylori organisms (GI Effects® Comprehensive Stool Profile, Metametrix, Palm Harbor, Florida). Stool PCR testing is not validated as a reliable sole measure in the diagnosis of H pylori, despite the accuracy of it. Few studies are available, although 1 suggests high specificity (98.4%) and good sensitivity (83.8%) compared with gastroscopy.15 Another study showed similar specificity (92.3%) but poorer sensitivity (62.5%) compared with histology.16 A third showed 100% specificity but only 42.6% sensitivity compared with urea breath test.17
We utilized stool PCR testing to identify symptomatic candidates for our nonprescription therapy. Presenting symptoms included 1 or more of the following: heartburn or dyspepsia, irritable bowel symptoms, gas and bloating, the presence of esophagitis or gastritis on endoscopy, or a history of peptic ulcer disease or unusual autoimmune disorders (eg, uveitis, autoimmune thrombocytopenia, or seronegative arthropathy). A total of 314 samples (26%) were found to be positive for H pylori. Of these, 39 patients were amenable to a trial of nonprescription therapy and completed a full 2-week course of treatment. These volunteers expressed a preference for nonprescription therapy, either out of concern for the effects of antibiotic treatment or due to intolerance of previously approved antibiotic regimens for H pylori.
Our nonprescription treatment consisted of the following supplements taken simultaneously:
- mastic gum (Jarrow Formulas, Los Angeles, California ): 500 mg, 1 capsule 3 times daily;
- emulsified oil of oregano in A.D.P. 50 mg (Biotics Research Corporation, Rosenberg, Texas): 1 tablet 3 times daily;
- Pepto-Bismol: 4 to 6 tablets daily in divided doses between meals;
- Vital 10 (Klaire Laboratories, Reno, Nevada) a broad-spectrum probiotic containing 5 billion colony forming units of 10 probiotic strains: 1 capsule twice daily; and
- Herbulk (Metagenics, Gig Harbor, Washington) a 5:2 blend of soluble-to-insoluble fiber: 14 g per day (10 g of soluble, 4 g insoluble fiber) mixed in water.
Results
Of 314 patients found to test positive for H pylori by PCR stool testing, 39 proceeded with our nonprescription treatment protocol and were tested a second time following treatment. All 39 patients completed a 2-week course of treatment incorporating mastic gum, oil of oregano, and bismuth.
Overall, nonprescription therapy gives patients and physicians another option when faced with Helicobacter pylori infection, and it has the benefit of helping to promote the balance of intestinal flora while having potentially fewer side effects than antibiotics.
There were no withdrawals from the treatment protocol. Fewer than 10% (n=3) of patients experienced minor abdominal cramping or increased gas. None had intolerable symptoms that interfered with completion of the protocol. Repeat stool PCR testing was obtained between 2 weeks and 12 weeks after the treatment protocol was completed.
Posttreatment testing of the 39 patients showed that 29 participants (74.3%) had converted to negative, suggesting complete biological eradication of H pylori. Since we were unable to obtain data for the type or strain of H pylori organisms, it is unknown which strains were most sensitive to our regimen. Four of the participants who failed to respond to this treatment were subsequently prescribed standard antibiotic therapy (lansoprazole, amoxicillin, clarithromycin or Prevpac) and retested. Two of these 4 converted to H pylori‒negative, while 2 remained H pylori‒positive as tested by PCR, suggesting that some H pylori infections were refractory to both our nonprescription protocol as well as to Prevpac. Six of the participants who failed to achieve results with the herbal therapy declined further treatment and were lost to follow-up during the study. All successfully treated patients also showed improvement in their presenting symptoms of dyspepsia or irritable-bowel type symptoms.
Discussion
Our in-house tracking of patients shows that combination over-the-counter, nonprescription products may have significant effectiveness in eradicating some but not all H pylori from the digestive tract. We found this treatment protocol to be well tolerated and also helpful in alleviating common digestive symptoms of heartburn, indigestion, constipation, and irregular bowel habits. By using a highly sensitive PCR technique for detection of H pylori, our results show evidence for significant reduction in the presence of H pylori. However, our methods could not differentiate the presence of the organism from pathological infection. Likewise, we were not able to identify which strains of H pylori were more susceptible to our regimen. It’s possible that our protocol may have eradicated commensal strains of H pylori as well as pathological ones. Still, it has been argued that the benefits of eradication clearly outweigh the potential benefits of chronic colonization.18
Summary
We have successfully treated 39 patients using over-the-counter herbal and nonprescription products. All patients completed a 2-week course of treatment. Each patient underwent pretreatment and posttreatment diagnostic testing using PCR stool analysis for the presence of H pylori. Our results showed successful eradication of H pylori and an improvement in gut flora after using over-the-counter herbs and a probiotic in 74.3% of subjects treated.
Conclusion
We found a well-tolerated, nonprescription “cocktail” effective in reversing the detection of H pylori and improving nonspecific digestive symptoms. Combination nonprescription treatment, based on an over-the-counter protocol, may be helpful in eradicating some strains of H pylori. Further study of this therapy is warranted.
