Helicobacter pylori infection: the most effective dietary supplements

Helicobacter pylori is a gram-negative, spiral-shaped bacterium that primarily colonizes the human gastric mucosa. Discovered in 1983 by Warren and Marshall, this bacterium is mainly associated with chronic gastritis, gastric and duodenal ulcer, as well as certain forms of gastric cancer​​. H. pylori is the only known bacterium capable of surviving in the highly acidic environment of the stomach, thanks to the production of urease which neutralizes gastric acidity. Its helical shape and flagella allow it to move through the gastric mucus and adhere to the stomach lining. Once established, it secretes toxins that damage the epithelial cells of the stomach, promoting inflammation and the development of lesions.

Epidemiology

Infection with H. pylori is primarily acquired in the first years of life and often persists indefinitely if not treated. The prevalence of infection varies by region of the world, with a higher incidence among older people and those who grew up in disadvantaged socioeconomic conditions. At least 50% of the worlds population is infected with H. pylori​​.

Symptoms

Infection with H. pylori can be asymptomatic, but when symptomatic it presents with epigastric pain, nausea, loss of appetite, and a feeling of bloating. The infection can lead to a vitamin B12 deficiency. This is explained by the fact that the bacterium disrupts nutrient absorption in the stomach. There is also a link between H. pylori and certain non-digestive disorders, such as autoimmune diseases (lupus, psoriasis) and chronic inflammatory or neurodegenerative conditions.

Diagnosis

Diagnosis of H. pylori infection can be established by invasive and non-invasive methods: • Invasive tests : gastric biopsies obtained during gastroduodenoscopy for rapid urease tests and histological examinations. • Non-invasive tests : detection of specific antibodies in serum, labeled urea breath tests and antigen tests on stool​​.

Complications

The main complications of H. pylori infection include: • Ulcerations : The bacterium is a major cause of duodenal and gastric ulcers, by stimulating gastric acid secretion. • Gastric cancer : Chronic infection with H. pylori is an established risk factor for the development of stomach cancer. • MALT lymphoma : Infection is also associated with a specific form of gastric lymphoma that may regress after eradication of the bacterium​.

Treatment

Treatments for H. pylori infection are mainly based on the use of antibiotics combined with proton pump inhibitors (PPIs) to reduce gastric acidity, which increases the effectiveness of the antibiotics. Triple therapy is the most commonly used first-line treatment. It consists of the combination of two antibiotics and a PPI : • PPI : Omeprazole, lansoprazole, pantoprazole, rabeprazole, or esomeprazole. • Antibiotics : Amoxicillin and clarithromycin, or metronidazole in patients allergic to penicillin. In case of high resistance to clarithromycin (≥20%) or failure of triple therapy, a quadruple therapy may be used : • PPI : As above. • Bismuth : Bismuth preparations. • Antibiotics : Tetracycline and metronidazole. New approaches are emerging, such as the use of probiotics, notably Lactobacillus reuteri DSMZ17648, which acts by reducing the bacterial load in the stomach and facilitates the elimination of H. pylori, without affecting the intestinal microbiota. Prevention of H. pylori infection involves strict hygiene measures, such as hand washing, consuming clean water and thorough cleaning of food.