After H. pylori Treatment, and the Burn Is Still There

You did everything the course asked: the pills morning and night, the metal taste, the alarm on your phone. Then the result came back clear, and the people around you took that as the last page. Your stomach didn't read it.

So you kept going on your own. The coffee went first, then the wine, the tomatoes, the ibuprofen in the bathroom drawer. Supper moved earlier. At a friend's table you say you've already eaten, because explaining takes longer than skipping.

The numbers say you are not alone in this. In the Japanese study of more than 23,000 endoscopy records, 28.7% of people who had cleared H. pylori went on to report upper abdominal pain or bloating, and that matched the rate in people who had never been infected¹. The editorial on that study lists changes in acid secretion, a more sensitive stomach and shifts in the stomach's bacteria as possible reasons¹.

Almost everything you've done since is subtraction: less coffee, less heat, less acid, no late meals. It is patient, private work. But subtraction has a limit. You can clear the whole counter and still have a stomach that feels unguarded.

There are a few causes worth ruling out first.

The infection may have survived. Cure rates for standard regimens have been falling in the United States for two decades, so the American College of Gastroenterology says everyone treated should have a test of cure².

Something may sit alongside it. In a meta-analysis of 27 studies, reflux esophagitis seen at endoscopy was more common after eradication therapy (relative risk 1.46), though reflux-related symptoms did not differ between groups⁴. Indigestion is also more common in people taking NSAIDs, the painkiller family that includes ibuprofen and naproxen³.

Indigestion can outlast the infection. Clearing H. pylori does not always end long-running indigestion. A review of 29 trials and 6,781 H. pylori-positive people with functional dyspepsia found that treatment cured symptoms in about 1 extra person for every 14 treated, compared with control treatment. The authors called the benefit modest⁵.

Then there is the shelf above the kettle: the acid reducer for bad evenings, slippery elm, DGL, a tub of glutamine, two kinds of probiotic, and a phone note of every food you've crossed off. None of it is silly. The research below asks a different question, about what happens inside the stomach's own cells.

The American College of Gastroenterology advises a test of cure for everyone who was treated, because eradication rates with traditional regimens have been declining in the United States over the past two decades². Which test, and when:

The same guideline says to avoid bismuth and antibiotics for at least 4 weeks before the test². Standard-dose antacids and H2 blockers do not affect its accuracy².

A few signs don't belong in a wait-and-see log. The ACG and CAG dyspepsia guideline lists unexplained weight loss, anemia, trouble swallowing and persistent vomiting as alarm features³. The ACG H. pylori guideline also lists GI bleeding as an alarm feature², so vomiting blood or passing black stools goes to a doctor promptly.

What your doctor may do next

For ongoing indigestion after a negative H. pylori test, the same guideline suggests a trial of a PPI, then a tricyclic antidepressant or a prokinetic if that doesn't help³. It suggests an endoscopy for people aged 60 and over with dyspepsia, and says people at higher risk of cancer, such as those with a family history, could be offered one at a younger age³. Your log of where the burn sits, when it starts and what makes it worse is the part only you can supply.

If the test of cure is positive

A positive test means the infection is still there. The ACG guideline prefers a 14-day "optimized" bismuth quadruple regimen if you haven't had one before, and suggests 14-day rifabutin triple therapy if you have². Regimens built on clarithromycin or levofloxacin should be used only when susceptibility has been confirmed².

So far the question has been what to keep away from the lining. The research on sulforaphane asks what is going on inside the cells, where leaving something out can't reach.

Nrf2, inside the gastric cells themselves

Sulforaphane comes from broccoli. Sprouts carry it in large amounts, stored as a precursor called glucoraphanin⁶.

What matters here is where it works: through a switch inside the cells called Nrf2, which turns on the cell's own antioxidant and detox enzymes. In mouse work, its protective effect in the stomach came from switching those enzymes on, and it was lost in mice bred without the Nrf2 gene⁷.

The same pattern showed up with H. pylori. In infected mice, sulforaphane-rich sprouts reduced inflammation in the stomach lining, and that effect was not seen in mice without Nrf2⁶. The authors read this as pointing to the cell's own Nrf2-dependent proteins⁶.

The 8-week human trial

The same paper then went to people⁶. Forty-eight people with H. pylori were randomly assigned 70 grams of broccoli sprouts a day for 8 weeks, or the same weight of alfalfa sprouts, which contain no sulforaphane. The researchers tracked the urea breath test and the stool antigen test, both measures of how much H. pylori is present, and blood pepsinogens I and II, markers of stomach inflammation.

In the broccoli group, all three fell. In the alfalfa group, they didn't. Two months after people stopped, the readings were back where they started⁶. The effect lasted as long as the habit did.

A 2024 systematic review of the studies drew the wider picture: broccoli-family foods may lower the bacterial load, and sulforaphane and its derivatives showed notable reductions in pro-inflammatory markers⁸.

The practical part happens at the counter: three questions on the back of the pouch tell you more than anything on the front.

1. Does it name both parts? Broccoli stores sulforaphane as glucoraphanin⁶, and an enzyme, myrosinase, turns one into the other⁹. In a small human study, sulforaphane from sprouts or seeds with their own active myrosinase was 3 to 4 times more bioavailable than from glucoraphanin given without it⁹. A label should name both, each on its own line.
2. Is every amount printed? Look for a milligram figure on every line. A "proprietary blend" hides the amounts.
3. Does it ask anything new of your week? You already carry a list of foods and a list of bottles. Look for a printed serving size and no new rulebook.

Here is the label of the one we make, line by line:

• 700 mg broccoli seed extract (13% glucoraphanin): the precursor
• 200 mg broccoli sprout extract with active myrosinase: the enzyme
• 100 mg mustard seed extract
• 50 mg vitamin C

A serving is two capsules, and a pouch holds 30 servings. The label states up to 30 mg sulforaphane per serving, and nothing else in your routine has to move.

Sproutly broccoli sprout capsules

Whatever you add, judge it on the trial's clock, not tonight's. If you can, log one week before you start, so you have something to compare against.

Weeks 1 to 2. Start the capsules, at the serving size on the label, and carry on as you are. Each evening, write three things: what time supper was, how the hours after it felt, how the next morning started.

Weeks 3 to 5. People drift here, because nothing dramatic happens. Keep logging the plain days as carefully as the hard ones. A calm Wednesday says something a single rough Saturday won't.

Weeks 6 to 8. Pick a slow morning and read the whole log against the week before you started. Only you can make that comparison, and the log keeps it honest.

Your doctor's plan stays exactly where it is throughout. Count only the hardest evenings and every long week looks like a setback. Count the quiet ones too, and the picture tends to be fairer.

For as long as you've lived with this, the answers have arrived as lists: what to leave out, what to keep in the cupboard, what to do before dinner and what never to do at night. Somewhere along the way the lists began to feel like a second illness.

Here are two lines to hold onto: your stomach already knows how to heal itself. It just needs the signal to start.

You can keep guarding the evening from the outside, with the same short list of foods and one careful week after another. Or you can add one steady thing and keep everything else: a serving of capsules from a label where every line has a number, your doctor's plan untouched, and a log that counts the plain days as closely as the hard ones.

If you'd like to try it, the capsules on the label above are Sproutly broccoli sprout extract. Your first order comes with a 90-day money-back promise from the day it is delivered, and no return is needed.

1. Lu JG, Gao YZ. Dyspepsia following Helicobacter pylori eradication: Shifts in etiology and clinical challenges (editorial on Suzuki et al., a retrospective cohort of more than 23,000 endoscopy records). World J Gastroenterol. 2026;32(6):115699. PMID 41695278
2. Chey WD, Howden CW, Moss SF, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2024;119(9):1730-1753. PMID 39626064
3. Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. PMID 28631728
4. Sugimoto M, Murata M, Mizuno H, et al. Endoscopic Reflux Esophagitis and Reflux-Related Symptoms after Helicobacter pylori Eradication Therapy: Meta-Analysis. J Clin Med. 2020;9(9):3007. PMID 32961949
5. Ford AC, Tsipotis E, Yuan Y, Leontiadis GI, Moayyedi P. Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis. Gut. 2022;71(10):1967-1975. PMID 35022266
6. Yanaka A, Fahey JW, Fukumoto A, et al. Dietary sulforaphane-rich broccoli sprouts reduce colonization and attenuate gastritis in Helicobacter pylori-infected mice and humans. Cancer Prev Res (Phila). 2009;2(4):353-360. PMID 19349290
7. Fahey JW, Haristoy X, Dolan PM, et al. Sulforaphane inhibits extracellular, intracellular, and antibiotic-resistant strains of Helicobacter pylori and prevents benzo[a]pyrene-induced stomach tumors. Proc Natl Acad Sci U S A. 2002;99(11):7610-7615. PMID 12032331
8. Properzi S, Stracci F, Rosi M, Lupi C, Villarini A, Gili A. Can a diet rich in Brassicaceae help control Helicobacter pylori infection? A systematic review. Front Med (Lausanne). 2024;11:1454902. PMID 39741515
9. Fahey JW, Holtzclaw WD, Wehage SL, Wade KL, Stephenson KK, Talalay P. Sulforaphane Bioavailability from Glucoraphanin-Rich Broccoli: Control by Active Endogenous Myrosinase. PLoS One. 2015;10(11):e0140963. PMID 26524341