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Must We Continue to Antibioticize for H. pylori?

Majid Ali, M.D.

Millions of people worldwide are needlessly administered antibiotics— "antibioticized" seems a more apt term since antibiotics are designer killer molecules. Surprise! Yes, antibiotics are designed to kill life, albeit of microbes initially. This is not cheap dramatization. Let us take the case of Helicobacter pylori (H. Pylori), a bacterium that is considered to be a cause of stomach ulcers. Indeed, a Nobel Prize was awarded to two Australians, Robin Warren and Barry Marshall—a poor choice, in my opinion—for this discovery. Not unexpectedly, the power of the Prize coerced doctors to regularly prescribe antibiotics to kill the bug, even for patients without any symptoms. Doctors happily claimed that they had eradicated the microbe, as evidenced by negative lab tests after antibiotic treatment. So the myth of curing H. Pylori with antibiotics became etched in the marble of medical thinking. My first doubts about this success story arose in the early 1980s when I started using special stain to identify H. Pylori microbes under the microscope in stomach biopsy tissues.

Altered States of Bowel Ecology

In 1980, I published a monograph entitled "Altered States of Bowel Ecology," in which I focused on ecologic relationships among the various segments of the alimentary tract, using the word "bowel" for the entire tract. I summarized my microscopic observations of several thousand stomach and colon biopsies and argued that a narrow focus on areas of inflammations, infections, and ulceration in the various segments of the tract led to a poor understanding of the changes affecting the whole tract. I also pointed out the poor clinical results obtained with such an approach. I followed that with several chapters published in the syllabi of the instruction courses of American Academy of Environmental Medicine.

The average American child receives 10–20 courses of antibiotics by the time he or she is 18 years old. Linking the ecologic disruptions of the bowel to sugar and antibiotic abuse was not a stretch. Many holistic doctors were raising alarm about what they considered to be the "antibiotic-candida connection." That also supported, albeit in an indirect way, my notion of altered states of bowel ecology.

Doubts About the Pylori-Ulcer Connection

In the 1980s, I noticed that the tests for H. pylori nearly always became positive months after doctors claimed to have eradicated the microbe with antibiotics. This situation was similar to the case of C. difficile tests which became positive after putative eradication of microbes with antibiotics. I also recognized a close parallel with the case of "candidiasis" treated and "cured" with herbs and antifungal drugs by the practitioners of the so-called alternative medicine. These observations, along with the findings of my microscopic studies formed the basis of my then-rudimentary concept of altered states of bowel ecology. It was in this light that the H. pylori-gastritis-ulcer-cancer risk became increasing suspect in my mind. I regarded the H. Pylori issue as a part of the broader spectrum of gastric ecologic disturbances.

Within several years, some thoughtful and observant physicians became doubtful about the "pylori-ulcer cause-effect relationship and suspected that the microbe "was associated with an increased risk of ulcers and gastric cancer." Then in 1998, the British Medical Journal published an article arguing that H. pylori might not be a bad microbial actor.

H. pylori, the Dominant Stomach

The title of this article is likely to chagrin some readers who are committed to the use of antibiotics to completely eradicate H. Pylori from the stomach. To allay their concerns, I suggest that they consider the following quote from the prestigious science journal Nature (25 August 2011): "In the early twentieth century, Helicobacter pylori was the dominant microbe in the stomachs of almost all people. By the turn of the twenty-first century, fewer than 6% of children in the United States, Sweden and Germany were carrying the organism. Other factors may be at play in this disappearance, but antibiotics may be a culprit. For example, a single course of amoxicillin or a macrolide antibiotic, most commonly used to treat middle-ear or respiratory infections in children, may also eradicate H. pylori in 20–50% of cases.."

On October 31, 2011, The New York Times published a commentary on the above-cited Nature article that included the following quote of Dr. Martin Blaser of New York University, the author of the Nature report: "We’re talking about a bug [H. pylori] that’s been in the human gut for at least 58,000 years...There’s probably a reason for that." Dr. Blaser clearly thought about the ecologic relationship between the stomach and the microbe, and so provided further support for my concept of the altered gastric ecology, which allows the commensal H. pylori to worsen inflammation caused by other factors. Reducing the total gastric microbial burden with antibiotics explains the limited and temporary benefits of antibiotic therapy for H. pylori.

Treatment of Fulminating H. Pylori Infections

Should H. pylori be ever treated with antibiotics? Yes, but only for fulminating cases of gastritis. This answer is based on my clinical experience with severely sickened individuals. My purpose is not to eradicate the microbe but to control its rabid growth until healing of ulcers and gastritis can begin.

Does H. Pylori Cause Cancer?

I offer three considerations to answer the above question. First, H. pylori existed in the stomach of nearly all individuals in the U.S. about a hundred years ago, while the stomach cancer was rare. Second, H. pylori infections are generally encountered in young people while stomach cancer in the United States is largely a cancer of elderly persons. Third, stomach cancer is caused by chronic irritation of tissues and molecular inflammation triggered by a host of factors unrelated to the microbe.

The Human Microbiome Project

In 2008, the National Institutes of Health allocated $115 million to fund the Human Microbiome Project to identify microbes that reside on and within a healthy human being. One objective was to examine the role of the disappearing microbiota in the current obesity epidemic. This what NIH should have done fifty years ago. Still better late than never. One can only hope that the results of such research will not lead only to use of more drugs for narrow-focused issues. Rather, the research findings will foster ecologic thinking among doctors.

Related Tutorials

* INTRODUCTION TO MICROBIOLOGY

* Introduction to Inflammation, Infections, and Immunity

* What Is Inflammation?

* Infectious Diseases

* Must We Continue to Antibioticize for H. pylori?

* Castor Oil Rubs for Colicky Babies and Children

Sesame Oil: Why Is It One of My Darlings?

*  Anti-Inflammatory Spice Therapies for Arthritis

Anti-Inflammatory Topical Oil Therapies for Arthritis

* LAPs and TAPs Determine the Outcome in Infections Everywhere in the Body

* Viruses and Virology

 

 

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