Should conventional therapy or functional medicine be used to treat Helicobacter pylori (H. pylori) infection?

From the Guidelines

Conventional therapy is the preferred approach for treating H. pylori infection, as it offers the most reliable eradication rates, with a recommended first-line treatment of 14 days of bismuth quadruple therapy or concomitant therapy, depending on local resistance patterns and previous antibiotic exposure. The choice of therapy should be guided by the antibiotic susceptibility profile of the organism, if known, and the local prevalence of resistant organisms 1. The bismuth quadruple therapy is favored in areas of high dual resistance to clarithromycin and metronidazole, and concomitant therapy is appropriate for those patients from areas of high clarithromycin resistance where bismuth is not available.

Some key points to consider when selecting a conventional therapy regimen include:

• The duration of first-line therapies, with 14 days being recommended for all first-line treatments to ensure higher success rates 1
• The use of levofloxacin as a first-line therapy, which is not recommended for most patients due to concerns about antibiotic overuse and resistance 1
• The importance of confirming H. pylori eradication with a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after completing treatment

While functional medicine approaches can complement conventional treatment by focusing on dietary changes, stress reduction, and probiotics to reduce side effects and potentially improve eradication rates, they should not be used as a replacement for conventional antibiotic therapy. The best approach may be conventional antibiotic therapy followed by functional medicine strategies to heal the gut, restore microbiome balance, and prevent recurrence.

From the FDA Drug Label

Omeprazole and clarithromycin dual therapy and omeprazole, clarithromycin and amoxicillin triple therapy have been shown to be active against most strains of Helicobacter pylori in vitro and in clinical infections Amoxicillin, in combination with clarithromycin plus lansoprazole as triple therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease

The FDA drug label recommends the use of conventional therapy (triple therapy with omeprazole, clarithromycin, and amoxicillin, or dual therapy with amoxicillin and lansoprazole) for the treatment of H. pylori infection, as it has been shown to be effective in eradicating the bacteria and reducing the risk of duodenal ulcer recurrence 2, 3.

• Key points:
  • Conventional therapy is recommended for H. pylori infection
  • Triple therapy with omeprazole, clarithromycin, and amoxicillin is effective
  • Dual therapy with amoxicillin and lansoprazole is also an option
  • Functional medicine is not mentioned in the drug labels as a treatment option for H. pylori infection.

From the Research

Conventional Therapy for H. pylori

• Conventional therapy typically involves a combination of antibiotics and acid suppressors, such as omeprazole, amoxicillin, and clarithromycin 4, 5, 6.
• Studies have shown that triple therapy regimens, including two antibiotics and an acid suppressor, can achieve eradication rates of up to 90% 4, 5, 6.
• The choice of antibiotics and acid suppressor can affect the efficacy of the treatment, with some combinations showing higher eradication rates than others 4, 5, 6.

Functional Medicine Approach for H. pylori

• There is limited research on the use of functional medicine approaches for H. pylori eradication.
• However, some studies suggest that quadruple therapy regimens, which include an additional antibiotic, may be effective in eradicating H. pylori 7.
• Other studies have investigated the use of alternative therapies, such as probiotics and herbal supplements, in combination with conventional antibiotics, but more research is needed to determine their efficacy 8.

Comparison of Conventional and Functional Medicine Approaches

• Conventional therapy has been shown to be effective in eradicating H. pylori, with eradication rates ranging from 70% to 90% 4, 5, 6.
• Functional medicine approaches, such as quadruple therapy regimens, may offer alternative treatment options for patients who have failed conventional therapy or have antibiotic resistance 7.
• However, more research is needed to determine the efficacy and safety of functional medicine approaches for H. pylori eradication.

Treatment Outcomes and Safety

• Treatment outcomes and safety can vary depending on the specific regimen used and the individual patient's response to treatment 4, 7, 5, 6, 8.
• Common adverse events associated with H. pylori treatment include gastrointestinal symptoms, such as nausea and diarrhea, as well as taste disturbances and headache 4, 5, 6, 8.
• Serious adverse events are rare, but can include allergic reactions and antibiotic-resistant infections 4, 7, 5, 6, 8.