A 35-year-old male presents with severe burning neuropathic-type pain in both lower limbs for the past 6 months, significantly affecting sleep and daily function. Pain is continuous, resistant to pregabalin/gabapentin/duloxetine, and NCS + EMG + MRI + B12 and autoimmune/heavy metal/metabolic workup are normal.
Initially evaluated as possible small fibre neuropathy (SFN) or even functional pain, as no demonstrable abnormalities were detected. Psychiatry trial also failed.
Important new development:
Patient has been taking proton pump inhibitors (PPI) daily for >1 year due to chronic epigastric burning. Upper GI endoscopy revealed severe gastritis with Helicobacter pylori infection. He was started on standard H. pylori eradication triple therapy — and his epigastric pain resolved within 15 days.
This now brings attention to the recognized but under-discussed association between chronic H. pylori infection and unexplained sensory neuropathic pain, possibly due to:
- Chronic immune activation → small fibre inflammation
- Molecular mimicry / autoantibody-driven neuropathy
- Increased pro-inflammatory cytokines (IL-6/TNF-α) affecting dorsal root ganglia
- Subtle micronutrient malabsorption despite normal B12 level
- Central sensitization triggered by chronic gut–brain axis stimulation
This opens the possibility that H. pylori–induced neuroinflammation or immune-mediated small fibre dysfunction could have been a contributor or amplifier of his neuropathic pain.
