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Heartburn: Don't Blame Stress; It's Usually An Infection

   By: Gabe Mirkin, M.D.

If you belch or have burning in your stomach or chest, particularly when your stomach is empty, you have either an infection, a tumor, or a condition called GERD in which you belch and have pain and don't have the foggiest idea why. Your gastroenterologist probably will want to put a tube down your mouth and into your stomach, but the biopsy that he will do to find the germ can often miss the germ when it is there.

At least 24 different bacteria have been shown to cause stomach ulcers. Since doctors do not have any way to check for all 24 different bacteria, all people with belching and burning in the stomach should be given the one-week course of antibiotics that is used to treat the most common cause of stomach ulcers, called Helicobacter Pylori.

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

Twenty years ago, everone 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 infection with helicobacter pylori and could be cured with antibiotics. Fellow physicians were so mean to him that he responded by swallowing a vial of helicobacter and almost died. This year he won the Nobel Prize for his discovery and his courage.

Now almost every reasonable physician agrees that all people who have belching 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 that germ. They are clearly wrong because many other bacteria can cause the same symptoms, including 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 transmitted between family members and pets. So some doctors prescribe antibiotics to all people with belching and stomach burning, and check the other members of the household for symptoms. The standard treatment, one week of clarithromycin 500 mg twice a day, metronidazole 500 mg twice a day and omeperazole 20 mg once a day, is safe and effective.

At least 12 weeks later, you need a follow up blood test for helicobacter. If your symptoms are gone and the titre drops, you are probably cured. If your helicobacter titre is still high, your helicobacter is probably resistant to metronidazole and you need to be treated for at least ten days with amoxacillin 500 mg four times a day, tetracycline 500 mg three times a day and omeperazole 20 mg once a day. If you have regurgitation of stomach acid into your esophagus (reflux, hiatal hernia), you may need to be treated with 20 mg omeperazole once a day. Some people who are not infected with helicobacter may benefit from taking clarithromycin or other antibiotic for a longer period of time. Check with your doctor.

Helicobacter may also cause liver disease, blood vessel diseases such as clotting and heart attacks, and certain skin conditions such as rosacea.

For journal references on this article see

Dr. Gabe Mirkin has been a radio talk show host for 25 years and practicing physician for more than 40 years; he is board certified in four specialties, including sports medicine. Read or listen to hundreds of his fitness and health reports at

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