I have worked with many people who underwent conventional H Pylori treatment that wasn't effective. This appears to largely be attributable to H Pylori's protective biofilm, protecting it from antibiotics (in fact, biofilm structures can make the bacteria up to 1,000 times more resistant to antibiotics) (1,2,3).
While I don't believe eradication needs to always be the goal for H Pylori, I do think that if someone is going down that treatment path, providing some support around the biofilm is essential. Bismuth has been shown to increase the efficacy of H Pylori treatment, and is known to be effective against bacterial biofilms, so it is possible this is one of the mechanisms by which it is working (4). In addition to bismuth, curcumin, NAC, lactoferrin, and ginger may also exert biofilm disrupting properties against H Pylori (5,6,7,8,9,10) and may be beneficial to include in a protocol.
Biofilms can make bacteria up to 1,000 times more resistant to antibiotics and are a significant reason why H Pylori treatments are ineffective. By including compounds such as bismuth, NAC, lactoferrin, and/or ginger into a H Pylori protocol we can increase the efficacy.