Patient who had done H. pylori cleanse for 30 days. Which probiotics and enzymes do you recommend for her to take once the retest comes back negative? This particular patient had an ulcer. Should I use enzymes without HCl? Is there is a test to measure the state of her stomach lining?

Chris Kresser: Yes. With a history of ulcer, I would typically avoid HCl. As for enzymes, for me they are just as needed. I don’t prescribe them as a rule unless the patient really feels better with enzymes or unless they have a marker like low fecal elastase, which indicates pancreatic insufficiency and that they might benefit from enzymes. I wouldn’t just as a rule say that we need to follow up treatment with H. pylori with enzymes, but if you do, I would definitely find some use without HCl in them.