Send us a text

If you suffer from acid reflux or have a hiatal hernia, you've likely been tested for H. pylori (Helicobacter Pylori), a bacteria found in the stomach which is the number one cause of stomach and duodenal (top part of your small intestine) ulcers.

The most common way to test for it is during an endoscopy, although stool testing can be done as well.

The symptoms of H. pylori are a bit vague and can mimic acid reflux, making it often missed. Unfortunately a chronic infection has a lot of dangers associated with it so you want to test for it accurately.

Symptoms include: bloating, discomfort in the upper abdomen, nausea, early satiety (meaning you feel full quickly), and acid reflux symptoms. If you have a hiatal hernia these symptoms are very familiar to you, hence the need to make the distinction. You can certainly suffer from all 3: a hiatal hernia, reflux AND an H. pylori infection, but we can't miss the infection.

H. pylori creates many of the same side effects associated with PPIs. Due to its effect upon the acid producing cells in your stomach you can malabsorp important nutrients including magnesium, folate, vitamin B12 and iron. 

I decided to film this video because I've been asked several time why testing doesn't agree. An endoscopy won't show the infection, but a stool test will. Of course that leaves one wondering which test is correct.

Let's look at the two tests and how they compare.

An endoscopy misses H. pylori 30 to 50% of the time. 
Why? It's due to something called sampling bias. The biopsy is taken from certain parts of the stomach only (the antrum and body - which is the lower stomach and main "body"). The problem with this is 2-fold. There are other parts of the stomach not addressed: the cardia, fundus and pylorus. 

Plus, H pylori can colonize in a patchy distribution meaning you can be in the right area but still miss it. It's especially difficult if the patients uses PPIs (that's a big one considering their widespread use), has stomach cancer or atrophic gastritis. The latter can be caused from autoimmune diseases such as Hashimoto's thyroiditis and Type 1 diabetes. Atrophic gastritis increases your risk of stomach cancer.

Endoscopic biopsy is very susceptible to false negatives (you have the infection and it fails to detect it) with patients who have taken a PPI, antibiotic, or bismuth during the past 2 to 4 weeks!

Let's move on to stool testing. Note: All stool testing is NOT created equal. Therefore, please ensure that any stool test your doctor orders for you covers all the points I'm about to discuss. Typically they do not through a conventional medicine doctor, but double check.

1. A benefit of stool testing is that it captures H pylori shed from the entire stomach lining.
2. The right test will utilize PCR DNA testing that is able to detect H. pylori with a high sensitivity and specificity, even at low levels. This is exactly what you want.
3. Stool testing is not affected by the use of PPIs, antibiotics or bismuth (think Pepto-bismol).
4. DNA testing can detect genetic material of the bacteria from live and recently dead organisms. Again, a more sensitive detection.
5. The "right" testing detects antibiotic resistance genes. e.g. Clarithromycin and other medications commonly used to treat the infection. If you particular H. pylori infection is resistant to the common drugs used to treat it, you won't successfully eradicate it. These tests prevent useless treatment from occurring.
6. H. pylori is a known carcinogen. The "right" testing looks at virulence factors (genes). Most common is: cagA - linked to a higher cancer risk. chronic gastritis also puts you at higher risk for stomach cancer. And vacA, associated with ulcer formation.
Many think H. pylori is a