Melatonin treats H. pylori, gastric ulcers and more
Jacob Schor, ND, FABNO
June 24, 2013
A Russian study on using Helicobacter pylori infections has caught my attention. Helicobacter or H. Pylori is that famously peculiar little bacteria that causes stomach ulcers. Peculiar, that’s because everyone thought that the stomach was far too acidic an environment for a bacteria to survive in. Famous, because the two Australian scientists who proved that indeed it could live in the stomach and cause ulcers were awarded the 2005 Nobel Prize for doing so.
Anyway these Russians, recruited a bunch of patients with duodenal ulcers (DU), another 30 with chronic non-atrophic gastritis (CNAG), and another 30 with plain old chronic atrophic gastritis (CAG) plus a dozen healthy people as controls. Those with DU or CNAG had confirmed H pylori infections.
The 100 DU patients were divided into two groups. Both groups went through a standard 7 day course of treatment for H. pylori infection that included omeprazole (20 mg BID), claritromycin (500 mg BID) and amoxicillin (1000 mg BID). One group also took 3 mg of melatonin at bedtime.
Both groups continued taking the omeprazole for a full two months. The melatonin group continued taking the 3 mg dose for the two months along with the omeprazole.
Adding the melatonin to this standard drug protocol increased the efficacy of H. pylori elimination and accelerated the healing of the ulcers. 
While we have kind of thought that melatonin would do this, it’s nice to have our hunches confirmed.
While many patients are aware that melatonin can be useful in treating insomnia, few are aware of its beneficial impact on the gastrointestinal tract. We think of melatonin as the hormone produced in the brain by the pineal gland yet far more melatonin is actually made by enteroendocrine cells that line the digestive tract.
Bowel habits follow clear circadian rhythms and it is the melatonin that regulates this timing. Dietary l-tryptophan increases blood levels of melatonin, even in animals that have had their pineal glands removed. L-tryptophan is converted to serotonin in the intestine that in turn is converted into melatonin. The nighttime surge in melatonin comes from the pineal gland but the gastrointestinal tract maintains baseline levels. Melatonin levels in the gut are ten to a hundred times higher than in the blood. 
This is not the first study to report melatonin has benefit in treating H. pylori. In two studies published in 2011, Celinski et al reported that either melatonin or l-tryptophan helps heal gastric and duodenal ulcers resulting from H. pylori infections in humans. They gave all patients omeprazole 20 mg twice a day and then added either melatonin 5 mg twice a day or tryptophan 250 mg twice a day. Both melatonin and tryptophan sped healing compared omeprazole alone. [3,4]
A number of reports suggest that melatonin may be useful in treating gastroesophageal reflux disease (GERD). This was first brought to our attention by de Souza Pereira who in a May 2006 letter to the Journal of Pineal Research, described a 64-year-old woman whose GERD responded well to a formula containing melatonin (6 mg). Later that same year de Souza Pereira reported the results of a clinical trial in which they gave 176 patients this melatonin containing product and 175 patients omeprazole (20 mg). All of the patients receiving melatonin supplements “reported a complete regression of symptoms after 40 days of treatment.” Only 65.7% of those receiving omeprazole reported similar improvement. 5
Madalinski in 2011 suggested that melatonin might protect against development of
“… erosive esophagitis, …. esophageal stricture, Barrett's esophagus and extra-esophageal damage (including the lungs, throat, sinuses, middle ear and teeth)…. [all of which are] major risk factors for esophageal carcinoma.” 
The benefits of melatonin aren’t just limited to esophagus and stomach but extend down to the pancreas and liver. Melatonin “…. prevents various forms of gastritis and pancreatitis through the activation of specific MT2-receptors and scavenges reactive oxygen species (ROS). Melatonin counteracts the increase in the ROS-induced lipid peroxidation and preserves, at least in part, the activity of key anti-oxidizing enzymes such as superoxide dismutase”  In a 2011 study of 75 patients with acute pancreatitis, high levels of endogenous melatonin played a protective role and were associated with a milder course of disease. 
Melatonin may also protect against gall stone formation. It reduces biliary levels of cholesterol by inhibiting cholesterol absorption across the intestinal epithelium and by increasing conversion of cholesterol to bile acids.  In a study of forty-five patients with steatohepatitis (what we usually call fatty liver) produced a, “… statistically significant reduction in GGTP, triglycerides and proinflammatory cytokine levels…” 
The bottom line is simple: In melatonin we have a potent tool to help protect and heal the gastrointestinal tract. Melatonin should now be considered in the treatment of H. pylori, gastric and duodenal ulcers, gastrointestinal reflux disease, pancreatitis and gall bladder disease. This study just adds further evidence to support melatonin’s use.
1. Osadchuk MA, Sibriaev AA, Kireeva NV, Kvetno? IM. [The influence of melatonin included in the combined treatment of antichelicobaterial therapy on immunohistochemical characteristics of gastric epitheliocytes from patients with duodenal ulcer]. Klin Med (Mosk). 2012;90(12):48-52.
[Article in Russian]
2. Schor J. Melatonin and the Gut. International Journal of Naturopathic Medicine. http://intjnm.org/?p=612
3. Celinski K, Konturek PC, Konturek SJ, Slomka M, Cichoz-Lach H, Brzozowski T, Bielanski W. Effects of melatonin and tryptophan on healing of gastric and duodenal ulcers with Helicobacter pylori infection in humans. J Physiol Pharmacol. 2011 Oct;62(5):521-6.
4. Celinski K, Konturek SJ, Konturek PC, Brzozowski T, Cichoz-Lach H, Slomka M, Malgorzata P, Bielanski W, Reiter RJ. Melatonin or L-tryptophan accelerates healing of gastroduodenal ulcers in patients treated with omeprazole. J Pineal Res. 2011 May;50(4):389-94.
5. Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006 Oct;41(3):195-200.
6. Madalinski MH. Does a melatonin supplement alter the course of gastro-esophageal reflux disease? World J Gastrointest Pharmacol Ther. 2011 Dec 6;2(6):50-1. doi: 10.4292/wjgpt.v2.i6.50.
7. Jaworek J, Brzozowski T, Konturek SJ. Melatonin as an organoprotector in the stomach and the pancreas. J Pineal Res. 2005 Mar;38(2):73-83.
8. Belyaev O, Herzog T, Munding J, Bolik B, Vosschulte A, Uhl W, Müller CA. Protective role of endogenous melatonin in the early course of human acute pancreatitis. J Pineal Res. 2011 Jan;50(1):71-7. doi: 10.1111/j.1600-079X.2010.00811.x. Epub 2010 Oct 22.
9. Koppisetti S, Jenigiri B, Terron MP, Tengattini S, Tamura H, Flores LJ, Tan DX, Reiter RJ. Reactive oxygen species and the hypomotility of the gall bladder as targets for the treatment of gallstones with melatonin: a review. Dig Dis Sci. 2008 Oct;53(10):2592-603. doi: 10.1007/s10620-007-0195-5. Epub 2008 Mar 13.
 Cichoz-Lach H, Celinski K, Konturek PC, Konturek SJ, Slomka M. The effects of L-tryptophan and melatonin on selected biochemical parameters in patients with steatohepatitis. J Physiol Pharmacol. 2010 Oct;61(5):577-80.