H. pylori Infection: When Treatment Is Necessary (and When It’s Not)
What is Helicobacter Pylori (H. Pylori)?
Helicobacter pylori, commonly known as H. pylori, is a common bacteria that infects the stomach lining.
It is estimated that over half the world's population carries H pylori, but only a small percentage will develop symptoms.
While H. pylori infection can be asymptomatic, it can also lead to various digestive issues, including gastritis, peptic ulcers, and in rare cases, even stomach cancer.
H. Pylori Infection Main Symptoms
H. pylori infection is usually acquired through contaminated food or water, or via an infected family member (this can even be your pet). The bacteria burrows its way into the stomach lining, causing inflammation and disrupting the stomach's natural balance and acidity level.
This can lead to a range of symptoms, including:
Bloating and gas
Stomach pain, especially when the stomach is empty
Loss of appetite
Nausea
Frequent burping
Heartburn, reflux, or GERD
Peptic or duodenal ulcers
Gastritis (inflammation of the stomach lining)
Many people carrying H. pylori will never experience significant digestive symptoms. Deciding whether to treat is a clinical decision that should balance symptom burden, risk factors, test results (including virulence markers when available), and individual context.
In younger children, it has even shown to be beneficial and protective in certain cases. Treatment for H. pylori infection remains a personal choice and you should always consult your health practitioner so that you are making an informed decision for your specific circumstances.
Testing for Helicobacter Pylori
If you suspect you may have an H. pylori infection (reflux unresponsive to typical approaches, unexplained gastritis, ulcers, or relevant family history), appropriate testing is key.
Common tests include:
Urea breath test — detects active infection
Stool antigen test — measures bacterial antigens directly in stools
Blood antibody test — indicates exposure but can’t differentiate active from past infection
Each testing option has its limitations (for example, PPIs and antibiotics can affect urea breath and stool tests), but stool antigen testing is considered a sensitive and practical choice in clinical practice. I find it to be the most accurate and the one I use in my practice. If you wish to test for H. pylori, you can book a session with me to discuss options and get a lab referral.
When H. pylori Should Be Treated
These are the cases in which evidence and clinical guidelines most consistently support treatment:
Confirmed peptic ulcer disease
Gastric MALT lymphoma
Confirmed gastritis with significant symptoms
History of gastric cancer or strong family history
High-risk virulence factors present (ex: cagA positive)
When H. pylori May Not Need Treatment
This is a crucial, nuanced point: not all H. pylori infections require eradication.
Recent articles have highlighted that H. pylori colonisation can be benign or even protective in some contexts.
Potential Protective Associations
Reduced risk of some esophageal diseases: Some studies have observed that individuals colonised with H. pylori have lower rates of GERD, Barrett’s esophagus, and esophageal adenocarcinoma, possibly because of altered gastric physiology resulting in less acid exposure to the esophagus.
Early childhood immune modulation: In younger children, some studies suggest that early colonisation may be associated with modulated immune responses, with possible decreases in asthma and allergy rates.
I tend not to recommend eradication particularly when:
There are no upper GI symptoms (asymptomatic)
Bacterial load is low on sensitive testing (detected but not flagged on GI-MAP), without virulence markers
There’s no evidence of ulcers or significant gastritis
In these cases, especially when H. pylori is detected incidentally, monitoring and supportive care may be appropriate rather than immediate eradication. This approach reflects the bacterium’s long co-evolution with humans and emerging insights into its complex effects on immunity and gastric ecology.
Treatment Options for H. pylori
H. pylori is known to be a resistant bacteria with strong protective mechanisms, making it hard to get rid of. When treatment is indicated, the current strategies include:
The Pharmaceutical Route (Antibiotic-Based Therapy)
The standard treatment for H. pylori infection involves a combination of two antibiotics, and a proton pump inhibitor (PPI) to reduce stomach acid. The most common antibiotics used are amoxicillin, metronidazole, or clarithromycin. This combination is known as "triple therapy."
Antibiotic resistance is a growing concern, affecting eradication success. Newer therapies, such as sequential therapy (a series of antibiotics) and quadruple therapy (PPI, multiple antibiotics, with added bismuth), have been developed to address this issue.
I will say that I have seen many people develop further digestive issues after completing such an aggressive protocol. Being an holistically-oriented practitioner, I usually don’t recommend this route to my clients unless they have tried other avenues first.
Natural and Supportive Approaches
Although pharmaceutical antibiotics remain the mainstream H. pylori treatment, a growing body of research suggests that natural therapies can play a significant role in supporting eradication and promoting overall gut health. Here's are herbals and compounds with supportive evidence:
Mastic Gum
Mastic gum, derived from the mastic tree, has been traditionally used for its medicinal properties. Studies suggest it possesses antibacterial activity against H. pylori. It is typically the base of any natural protocol against H pylori. In addition, it may help reduce inflammation and promote healing of the stomach lining.
Broccoli Sprouts
Broccoli sprouts are rich in sulforaphane, a potent compound with antibacterial and anti-inflammatory properties. Research suggests that sulforaphane can inhibit H. pylori growth and reduce its ability to adhere to the stomach lining.
Nigella Sativa (Black Seed)
Nigella sativa, also known as black seed, has been used for centuries in traditional medicine. Its active compound, thymoquinone, exhibits antimicrobial and anti-inflammatory properties. Studies suggest that nigella sativa may help suppress H. pylori growth and reduce stomach inflammation.
Ginger
Ginger is well-known for its anti-inflammatory and digestive-soothing properties. It can help reduce stomach pain, nausea, and bloating associated with H. pylori infection.
Garlic (Allicin)
Garlic contains allicin, a compound with antibacterial properties that has been studied in the context of H pylori eradication. Although the literature is not clear on whether or not allicin is truly effective against H pylori, it is a great and safe adjunct to any protocol in my opinion.
Linolenic Acid
Linolenic acid, an omega-3 fatty acid found in flaxseed oil and chia seeds, has shown potential in reducing H. pylori infection. It may help modulate the immune response and reduce inflammation in the stomach.
Berberine
This compound, found in plants like goldenseal and barberry, has shown antimicrobial activity against H. pylori. Berberine is also commonly used for SIBO treatment.
Other Natural Supportive Approaches
These are adjunctive, not replacements for indicated therapies.
Apple Cider Vinegar: While more research is needed, some anecdotal evidence suggests that apple cider vinegar may help balance stomach acid levels and reduce H. pylori growth.
Aloe Vera: Aloe vera juice is known for its soothing properties and may help reduce stomach irritation caused by H. pylori.
Matula tea: Derived from the Matula (Ptychopetalum olacoides) plant, is a traditional remedy used in South America for various ailments, including digestive issues. However, there is limited scientific research specifically on its effectiveness against H. pylori. Some anecdotal evidence suggests that this tea may help soothe stomach irritation and reduce inflammation.
In my personal experience, Matula tea hasn’t been effective in eradicating H pylori when I had it. I have heard of clients getting good results with it; in any case it is an option to consider if you have tried other approaches without any success.
Probiotics against H. pylori
Numerous studies have shown that probiotics can be a valuable ally in H. pylori treatment. It is important to understand however that they are a great addition to a protocol, but do not replace the need for other antimicrobial compounds. They can help:
Improve the success of standard antibiotic treatment.
Reduce the risk of developing disorders associated with H. pylori infection.
Inhibit H. pylori in the stomach: Some probiotic strains have shown promising results in reducing H. pylori infection. The main strains are:
Lactobacillus Reuteri DSM17648: This strain has demonstrated the ability to inhibit H. pylori growth and reduce inflammation in the stomach lining. Studies suggest it can enhance the effectiveness of standard antibiotic therapy.
Lactobacillus Casei & Lactobacillus Gasseri: These strains has been consistently identified as two of the most effective probiotics for improving H. pylori eradication rates. They can also help reduce inflammation and side effects associated with antibiotic treatment.
Bifidobacterium Infantis and Bifidobacterium Longum: These strains are known for their ability to modulate the gut microbiome and support a healthy immune response. They may help reduce inflammation and support the body's natural defense against H. pylori.
Saccharomyces Boulardii: This beneficial yeast has shown promising results in increasing the success of antibiotic triple therapy and reducing side effects like bloating.
Lifestyle Advice When Dealing with H. Pylori
A healthy diet plays a crucial role in supporting gut health and aiding in H. pylori eradication. Consider reducing processed foods, sugary drinks, and excessive caffeine as these can further contribute to gut imbalances. I also recommend slowly increasing your fiber intake and eating fermented foods like homemade yogurt, sauerkraut, and kimchi, which are naturally rich in probiotics.
Other lifestyle habits that can help your outcome are stress management and sleep quality:
Stress resilience: as we all know by now, stress negatively impacts gut health, and I see this especially with clients dealing with acid reflux or GERD. Implementing stress-reducing techniques like meditation, vagus nerve exercises, and deep breathing exercises can be beneficial.
Sleep: Getting enough sleep is essential for overall health, including gut health. It is your main ally for healing. Aim for at least 7-8 hours of quality sleep each night.
Important Considerations and Aftercare
Personalized Treatment: The best treatment approach for H. pylori infection will vary depending on individual factors like the severity of the infection, presence of virulence factors, symptoms, and potential allergies.
Follow-up testing: If you do treat, follow-up testing (stool antigen or breath test) is recommended to confirm eradication.
Long-Term Management: Even after successful treatment, it's crucial to maintain a healthy lifestyle and diet to prevent recurrence of H. pylori infection. I recommend throwing away your toothbrush once you are done with your protocol as H. pylori can remain in the brush fibers and reinfect you.
Microbiome care: Antibiotic therapy can impact your microbiome, so consider probiotics and dietary support during and after treatment.
H. pylori infection exists on a spectrum: from asymptomatic colonization with little clinical consequence to a driver of ulcers and cancer. Guided evaluation and shared decision-making with a clinician ensures the right choice for your health and long-term outcomes.
If you need support and personalized advice regarding treatment or your options, book a 1:1 consult with me below.