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
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
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.
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
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
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.
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.
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
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.
INTRODUCTION TO MICROBIOLOGY
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
Oil Therapies for Arthritis
LAPs and TAPs
Determine the Outcome in Infections Everywhere in
* Viruses and Virology