Helicobacter Pyloris: An Atypical Case

Helicobacter pyloris is a bacteria that infects the stomach lining.  This bug is associated with gastric ulcers, and to a much lesser degree, gastric cancer.  Half of the world's population is infected with this bacteria, but a large majority of those infected, display no symptoms. The transmission of this bacteria is thought to be from person to person via the oral-oral route or oral-fecal route.  One theory is that both water and houseflies act as reservoirs.

For those who are symptomatic, complaints of indigestion, stomach pain, nausea, heartburn, bloating and belching are common.

There is insufficient data regarding H. pyloris in the pediatric population.

Diagnosis involves one of 4 methods:  gastric analysis following endoscopy, a blood test (for antibodies to the bacteria), a urea breath test, or a stool test (for the antigen).  The blood test method is only useful for initial diagnosis but not for follow-up testing when assessing efficacy of treatment.  This is because the blood test will likely show circulating antibodies to the bacteria even after the eradication of the bug.

The choice of treatment with the highest proven success rate for this condition is a combination of 2 antibiotics along with a stomach acid lowering drug (usually a PPI or an H2 blocker).

A foster mom brought in her 13 year old boy to see me, diagnosed by her family physician as having chronic asthma.  This child presented with violent, frequent and continuous clearing of his throat, difficulty "catching his breath", generalized intense tingling and itching of his skin, severe insomnia, and marked restlessness throughout the day.

Mom had been giving him Melatonin 3 mg before bed each night to help him sleep, with good results.  However, none of his other symptoms improved with sleeping better.

He had been on an entire assortment of inhalers for asthma, none of which helped this boy's symptoms, and prior to seeing me, the next step for this child was for him to see a respirologist, a specialist in pulmonary diseases.

Listening to this boy "hork" violently every 5 - 10 seconds throughout his entire appointment with me was distressing.  And if I felt like that, I couldn't imagine what kind of distress this poor kid was going through.  I had never before heard anything like it in my life.

I asked the mother, "Does this ever stop?"

"No", she replied.  "Only when I give him the Melatonin and he's sleeping.  And sometimes he does this in his sleep".

"How long has this been going on for?" I asked.

"Ever since we got him, which was about 6 years ago.  I don' know what he was like before that with his biological mother".

Six years (that we know of, maybe more) of horking like that.  I couldn't imagine it.

When I examined him, his lungs were clear with good air entry throughout.  His peak flow reading was normal.  His respirations were normal, but he did appear to try and get a deeper breath, in between the violent throat clearings.

Then I examined his throat.  Never in all my life have I ever seen anything like it.  His pharynx was fiery red, swollen, and the entire surface was covered with numerous tear-drop shaped blisters, each about 0.5 cm in length.  I wasn't sure if what I saw was a result of pharyngeal trauma from the constant violent 6-year plus history of clearing his throat, or if there was another irritant that was compounding this boy's problem.

"I don't think his symptoms have anything to do with his bronchi or lungs.  You might be wasting your time seeing a pulmonary specialist, but I'm not sure right now.  I believe your child's symptoms are coming from his gut, even though he doesn't have any stomach symptoms."  This is what I said to his mother.

After determining his food intolerances, I recommended a restricted diet for the child which he adhered to with excellent compliance.  He returned in 1 month.  His restlessness greatly improved, his skin tingling and scratching were gone, but his horking was not much better.  The intensity of his throat clearing was a little less violent and the frequency had dropped to every 15 - 20 seconds;  but still far too distressing for this young boy.  On physical examination, is pharynx was unchanged.

It was then that I recommended we do a blood test, with a follow-up breath test for H. pyloris if the blood test ended up being positive.  The results of both tests were positive prior to starting treatment.  Even though there is little data on pediatric infections with H. pyloris, I opted to prescribe the triple antibiotic/PPI therapy to this child for the full 2 weeks instead of 1 week, given the length of time he likely had this bug.

Two months later he returned.  The violent clearing of his throat had completely disappeared.  Not even a mild clearing of his throat was heard.  His pharynx was almost normal, with no erythema, no swelling and only 1 blister left.

He remained as such for 6 months when I last heard from him.  I don't know if mom ever took my advice to seek out a pediatric gastroenterologist for follow-up care.  I hope so.

The best way to treat H. pyloris is with antibiotics.  However, there are those patients who do not respond to this type of therapy and have undergone numerous courses of treatment with no amelioration of symptoms and no eradication of the bacteria.  In those patients, I often use Mastica Gum, Oil of Oregano and Goldenseal which are largely effective in these types of patients, as observed via empirical evidence.  However, there is little scientific data to support botanical medicines in the treatment of H. pylori, except for maybe here.  I have no experience with Monolaurin.

In order to prevent antibiotic-induced illnesses, Probiotics (preferably dairy-free) are crucial to take after undergoing a course of antibiotic treatment for H. pylori.

The bottom line is this:  throat clearing may occasionally be the result of problems other than common conditions like post-nasal drip (chronic sinusitis) or food intolerance/allergy.  It just might be a bug lurking in your tummy.