Heartburn: Don't blame stress; It's usually an infection

Heartburn: Don't blame stress; It's usually an infection

If you burp or have a burning sensation in your stomach or chest, especially when your stomach is empty, you either have an infection, a tumor, or a condition called GERD where you burp and feel pain and have no idea why. Your gastroenterologist will probably want to put a tube in your mouth and into your stomach, but the biopsy he will perform to find the germ can often miss the germ if it is there.

At least 24 different bacteria have been shown to cause stomach ulcers. Because doctors have no way to screen for all 24 different bacteria, all people with belching and burning in the stomach should receive the week-long course of antibiotics used to treat the most common cause of stomach ulcers, Helicobacter pylori.

I recommend that you get an upper GI series x-ray to rule out a tumor, which is almost always negative. Then you will get a blood test for Helicobacter pylori and should be treated with antibiotics even if the blood test is negative, because there are at least 23 other types of bacteria that this test does not detect. Otherwise, you'll be stuck with a diagnosis of regurgitation called GERD and on medication for the rest of your life.

Twenty years ago, everyone believed that stomach problems were caused by stress. In 1983 they laughed at Dr. Barry Marshall when he reported that stomach ulcers were caused by Helicobacter pylori infection and could be cured with antibiotics. Fellow doctors were so mean to him that he then swallowed a vial of Helicobacter and almost died. That year he won the Nobel Prize for his discovery and courage.

Now almost every sensible doctor agrees that all people who have burping and burning in the stomach and a positive blood test for Helicobacter pylori can be cured with antibiotics, but many gastroenterologists stubbornly refuse to treat patients with a negative blood test or biopsy for this germ. They are clearly wrong as many other bacteria can cause the same symptoms including H. helmannii, H. felis, H. rappini, H. cinaedi, H. sp. Strain Mainz, H. fennelliae, H. pullorum, H. hepaticus, H. Billis, H. canis, H. Hills, H. mesocricetorum sp nov, cytomegalovirus and mycoplasma.

These germs also grow in saliva, so they can be passed between family members and pets. Therefore, some doctors prescribe antibiotics to all people with belching and stomach burns and check other members of the household for symptoms. The standard treatment, one week of clarithromycin 500 mg twice daily, metronidazole 500 mg twice daily, and omeperazole 20 mg once daily, is safe and effective.

At least 12 weeks later you will need a blood test for Helicobacter. If your symptoms have disappeared and the titer drops, you are probably cured. If your Helicobacter titer is still high, your Helicobacter is probably resistant to metronidazole and you need to be treated with amoxacillin 500 mg four times daily, tetracycline 500 mg three times daily, and omeperazole 20 mg once daily for at least ten days. If you regurgitate stomach acid into your esophagus (reflux, hiatal hernia), you may need treatment with omeperazole 20 mg once daily. Some people who are not infected with Helicobacter may benefit from taking clarithromycin or another antibiotic for a long time. Ask your doctor.

Helicobacter can also cause liver disease, blood vessel disorders such as clotting and heart attack, and certain skin conditions such as rosacea.

Inspired by Gabe Mirkin, M.D.