Helicobacter pylori is the most common gastrointestinal bacterial infection worldwide. We have been co-evolving for over 50,000 years with this bacterium, and over 50% of the population across the globe carry this in their gut. H. pylori has been medically found to contribute to stomach ulcerations, gastritis, acid reflux, and even stomach cancer. The bacteria can also contribute to symptoms such as nausea, loss of appetite, excessive burping, weight loss, aching in the stomach, and much more. A functional medicine approach to treating H. pylori can often include medications and/or herbal and botanical approaches intended to reduce bacterial counts.

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CC: Acid Reflux, Anxiety, Irregular Bowel Movements

Mary was a 27-year-old female complaining of acid reflux, constipation, bloating, anxiety, sleep issues, hair loss, recurrent vaginal yeast infections, and PMS. Mary was diagnosed with stress-induced gastritis and a lengthy list of food sensitivities from her previous practitioner. Mary had moved from country to country over the last 5 years and had a recent DNC, resulting in her being hospitalized with a panic attack and a diagnosis of anxiety and depression. Mary was prescribed antidepressants and sleeping aids for 2 months with slight improvement, but the anxiety and stress returned without a known cause.

Additional History

Prior to our initial session, Mary had recently moved to the US and started a "healthy, elimination diet" but started experiencing pain under the ribcage. She consulted with her functional medicine physician for a natural approach and was put on ginger tea with echinacea, omega-3s, adaptogens, vitamin D, lactobacillus rhamnosus, and coconut charcoal, alongside a low FODMAP diet. Mary experienced some improvement with this protocol but was still complaining of constant reflux when we met and a very restrictive diet.

Initial Lab Work

Comprehensive Stool Test Results:

• Helicobacter pylori high 2.0e3, negative virulence factors (normal <1.0e3)
• Dysbiotic flora high, elevated bacillus, enterococcus, staphylococcus spp., streptococcus spp, methanobacteriaceae family, prevotella spp, fusobacterium spp
• Parasite: blastocystis hominis high 4.50e6 (normal range <2.00e3)
• Elastase-1 low normal 415 (optimal range > 500 ug/g)
• Secretory IgA low 135 (normal range 510 - 2010 ug/g)

Small Intestinal Bacterial Overgrowth Results- negative

Lab Analysis

Mary's lab work points to three main issues that are contributing to her symptoms:

Presence of Helicobacter pylori in High Amounts

H. pylori decreases stomach acid production, which can downstream impact digestive enzyme production. This can expose us to more infections (such as blastocystis hominis and dysbiosis) or create an environment where digestion is poor (low normal elastase), leaving large food chunks to make it to our intestinal tract for bad bugs to feed on.

Presence of Blastocystis hominis in High Amounts

H. pylori and B. hominis are often seen together when testing the gut and can contribute to anxiety, poor digestion, diarrhea/bloating/constipation, and a weakened immune system (low secretory IgA).

Low Secretory IgA or Immune Response

A low immune response can impact how well we are able to fight and clear infections as well as tolerate foods. This is one of the most important markers on a comprehensive stool test, and supporting it before, during, and post-treatment can allow your patient to have far more successful outcomes.

Interventions:

• Start DGL Plus by Pure Encapsulations: 1 capsule per day to help soothe the gastric lining and reduce acid reflux symptoms
• Start Vital 10 by Klaire Labs: 1 capsule per day, taken away from Candibactin AR, probiotics have been shown to increase H. pylori eradication by up to 14%
• Start Mastic Gum by Jarrow Formulations: 2 capsules 2x/day between meals, this is the best monotherapy for eradication of H. pylori
• Start Candibactin AR by Metagenics: 1 capsule 3x/day, oregano can be an effective anti-microbial treatment for H. pylori, blastocystis hominis, yeast, as well as the dysbiotic flora found on her stool test
• Start Herbulk by Metagenics: 1 tbsp per day with plenty of fluids, increasing fiber has been shown to reduce stomach acid levels which temporarily can help the eradication process of H. pylori, as H. pylori thrives in acidic environments and embed themselves further into the gastric lining, making it more difficult to eradicate
• Start Interfase Plus by Klaire Labs: 1-2 capsules 2x/day between meals as a biofilm disruptor
• Start Bismuth chewable: 2 tablets 2x/day for only 2 weeks which can add up to 40% to eradication rates in resistant infections, disrupt adhesions, and act as an antimicrobial
• Start l-Theanine by Pure Encapsulations as needed for anxiety and stress response reduction
• Encouraged to work with our nutritionist to start incorporating a wide variety of foods and come off of the low FODMAP diet plan to start reversing food fear, increase polyphenols, prebiotic foods, and fiber chains to promote diversity in the gut and balance the microbiome

Follow Up 4 Weeks Later

At our one-month follow-up, Mary was feeling much better but still complaining of occasional acid reflux. She was no longer constipated or having diarrhea and felt a significant reduction in full-body inflammation, anxiety, and depression.

We continued treating H. pylori and the remaining bacteria and parasitic infection for approximately 4-6 more weeks by continuing mastic gum, Interfase Plus, DGL Plus, and Candibactin AR. Additionally, once the other previously mentioned supplements were finished out (fiber, probiotic, bismuth), we added in SBI Protect by Ortho Molecular, S. Boulardii by Ortho Molecular, and Mega Guard by Microbiome Labs.

SBI Protect can help support low secretory IgA, which likely only became lower through our initial treatment, and is imperative for maintaining a healthy gut and immune system.

S. Boulardii can both support low secretory IgA, as well as support eradication of H. pylori, B. hominis, and candida.

Mega Guard can help balance stomach acid and a healthy balance of H. pylori.

Repeat Labs After 8 Weeks of Treatment

Mary stated that she started to feel better after only 2 weeks into treatment. However, after 2-3 months, her acid reflux had completely resolved, and she was now H. pylori-negative on qPCR testing, which is the most sensitive testing on the market for H. pylori.

Small Intestinal Bacterial Overgrowth – did not run due to being negative initially.

Helicobacter pylori qPCR testing only- not detected, ruling in or out H. pylori prior to repeating full stool test panel.

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Summary

This case demonstrates how powerful using the right testing with reference ranges outside of positive and negative can be, especially before removing large food groups from one's diet. Mary knew that her anxiety and acid reflux went beyond stress and that there had to be a whole system way. This highlights the importance of trusting your own body and symptoms and working with providers that are open and encouraging to both proper testing and digging deeper for root causes.

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