pylori: Nobel prize awarded to discoverers
Links to information on Helicobacter and a review of natural treatments
that may be helpful
Nobel Price in Medicine was awarded this week to the two doctors, Barry
Marshall and Robin Warren, who discovered Helicobacter pylori and identified
it as the cause of stomach ulcers.
brief review of their work can be read at Science News:
Center for Disease Control has a fact sheet on Helicobacter at:
idea that stomach ulcers were caused by an infectious agent rather than
emotional stress was a new way of thinking for many doctors and it took
years for a change in clinical treatment to occur. This delay in scientific
knowledge being adopted into clinical practice was so pronounced that
it became the subject of several studies [i]
[ii] An excellent review article
on this history can be found at:
Gratification: Why it Took Everybody So Long to Acknowledge that Bacteria
the years I have paid a great deal of money to our favorite family therapist
to teach me to think of and use the word, “and”. This is a perfect example
where using that expensive little word pays off. Perhaps it is both infection
‘and' stress that causes stomach ulcers.
infections are transmitted during infancy, usually passed along from family
members. The infections stay dormant causing little or now symptoms until
later in life when they become active. Could it be that stress inhibits
the protective mechanisms of the body allowing the dormant Helicobacter
infection to become active? Stress typically lowers the production of
hydrochloric acid in the stomach; does the acid keep Helicobacter at bay?
Does stress set up the condition for the infection to erupt from its dormant
state and cause ulcers? Sounds good, but I confess I haven't found a study
that asks these questions directly.
therapy is not 100% effective against Helicobacter infections and this
has been an impetus to investigate possible alternative therapies that
inhibit Helicobacter growth.
Gaby, MD has recently written a good article reviewing possible alternative
therapies for treating Helicobacter. I am going to paste the full text
Dr. Gaby mentions an older study which suggests vitamin C may be of benefit.
A newer study published suggests that vitamin C provides no benefit. [iii]
by Alan R. Gaby, M.D.
Helicobacter pylori Eradication: Are There Alternatives to Antibiotics?
It is generally accepted that infection with Helicobacter pylori is
an important cause of peptic ulcer disease and that eradication of this
organism greatly reduces the recurrence rate of ulcers. H. pylori
also can cause chronic gastritis and hypochlorhydria and is a risk
factor for gastric cancer. Conventional eradication therapies, which consist
of two antibiotics plus either a proton-pump inhibitor or a bismuth compound,
are highly effective (cure rates are typically 85-90% or better). However,
these treatments can cause significant side effects in some cases, such
as pseudomembranous colitis (a potentially serious infection caused by
Clostridium difficile ) or overgrowth of Candida albicans
. Alternative methods of eradicating H. pylori are therefore
being investigated, as are methods of reducing the side effects of conventional
therapy. To date, the research in this area is still preliminary, and
no treatment has emerged as a clear alternative to the conventional triple-therapy
regimens. However, some natural substances may be useful, either in increasing
the eradication rate from standard therapy, or in reducing its side effects.
It should be noted that in vitro activity against H. pylori
does not necessarily imply an effect in vivo . In order
for a compound to exert an antibacterial effect in vivo , it
must achieve a bactericidal concentration in the gastric contents, penetrate
the protective mucus layer of the gastroduodenal lining, and maintain
its biological activity in the acidic environment of the stomach. Furthermore,
the absence of detectable H. pylori at the end of a course of
treatment is not sufficient evidence that the infection has been cured.
H. pylori is relatively easy to suppress, but difficult to eradicate
completely. Most researchers require a negative H. pylori test
four weeks after the completion of treatment before concluding that the
infection has been cured.
Sixty patients with dyspepsia, chronic gastritis, and H. pylori infection
were randomly assigned to receive antacids (control group) or 5 g/day
of vitamin C, administered in 4 divided doses (2 g, 1 g, 1 g, 1 g), for
4 weeks. 1
the end of the treatment period, H. pylori infection remained
unchanged in all 24 patients in the control group, whereas there was no
evidence of infection in 8 of 27 patients (30%) who completed vitamin
C therapy (p = 0.01). Unfortunately, all of the patients in the study
underwent conventional eradication therapy shortly after the trial was
completed, so it was not possible to determine whether the effect of vitamin
C on H. pylori infection was transient or long-lasting. However,
even a suppressive effect of vitamin C against H. pylori might
have clinical value, since most people can safely ingest moderate doses
of vitamin C indefinitely.
Polyunsaturated Fatty Acids
Fifteen patients with mild non-ulcer dyspepsia and H. pylori
infection were treated with 2 g/day of a 1:1 mixture of fish oil and black
currant seed oil for 8 weeks. 2
This mixture contains several fatty acids (e.g., linoleic acid, alpha-linolenic
acid, gamma-linolenic acid, and eicosapentaenoic acid) that have been
shown to inhibit H. pylori in vitro . Six months after
the end of treatment, 3 of the 15 patients (20%) had a negative urease
test, indicating that the infection had been cured. A placebo-controlled
study is needed to determine whether these results represent true H.
pylori eradication or spontaneous remission, which is known to occur
in some cases.
Lactobacilli have been shown to reduce the incidence of antibiotic-induced
gastrointestinal side effects in several studies. 3,4
effective dosage regimen was 6 x 10 9
GG organisms, given twice a day, 2 hours after breakfast and dinner,
for 14 days, during the week of eradication therapy and the following
week. Other probiotic organisms, including Saccharomyces boulardii
and Bifidobacteria have also been shown to reduce side
effects in patients being treated for H. pylori infection. 5
In addition to reducing side effects, preliminary evidence suggests that
lactobacilli might increase the effectiveness of antibiotic therapy. In
vitro, L. acidophilus has been shown to inhibit the growth of H.
pylori . 6
a study in humans, the addition of L. acidophilus to triple
therapy resulted in an eradication rate of 86.6%, as compared with 70%
when triple therapy was given alone. 7
Mastic gum is a resinous exudate obtained from the stem and leaves of
the mastic tree ( Pistacia lentiscus ), an evergreen shrub native
to the Mediterranean Basin. In a double-blind trial, administration of
mastic (1 g/day before breakfast) for 2 weeks resulted in an ulcer healing
rate of 78%, compared with 22% in patients given a placebo (p < 0.01).
Mastic has also been shown to kill H. pylori in vitro , but it
is not known whether it is capable of suppressing or eradicating H.
pylori in humans.
An aqueous extract of garlic cloves, standardized for its thiosulfinate
concentration, was found to inhibit the growth of H. pylori in vitro
, with a minimum inhibitory concentration of 40 mcg of thiosulfinate
per ml. 9
achieve that concentration of thiosulfinate using fresh garlic would require
approximately 5 g of garlic (2 small cloves) in a 500-ml volume of stomach
contents, which is considered a fairly modest dose of garlic. Despite
this evidence of an antibacterial effect in vitro , clinical
trials in patients with H. pylori infection have for the most
part been disappointing. 10,11
one study, however, supplementation with allicin (a compound present in
garlic) resulted in an eradication rate of 23.3%, and the addition of
allicin to conventional therapy increased the eradication rate from 66.7%
to 90%. 12
Lactoferrin is a protein, present in human and bovine milk, that has bacteriostatic
and bactericidal effects against various organisms. The antibiotic effect
of lactoferrin has been attributed to its ability to bind iron, thereby
preventing the utilization of iron by bacteria for growth. In addition,
lactoferrin appears to cause changes in bacterial membrane permeability
that might be expected to reduce the viability of the organisms. In a
randomized trial, 50 patients with H. pylori infection received
one week of triple therapy, with or without 200 mg of lactoferrin twice
a day. 13
eradication rate was 100% in the group receiving lactoferrin, compared
with 76.9% in the group not receiving lactoferrin (p = 0.023).
To date, no alternative therapy has been proven to be reliably effective
for eradicating H. pylori infection. Some treatments, however,
have been shown to reduce the side effects, or to enhance the effectiveness,
of conventional therapy. With additional research, using different combinations
and doses of some of the substances mentioned in this review, perhaps
a safe and effective alternative to triple therapy will be found.
References for Gaby Article:
1 Jarosz M, Dzieniszewski J, Dabrowska-Ufniarz E, et al. Effects of high
dose vitamin C treatment on Helicobacter pylori infection and
total vitamin C concentration in gastric juice. Eur J Cancer Prev
2 Frieri G, Pimpo
A, et al. Polyunsaturated fatty acid dietary supplementation: an adjuvant
approach to treatment of Helicobacter pylori infection. Nutr
3 Gotz V, Romankiewicz JA, Moss J, Murray
Prophylaxis against ampicillin-associated diarrhea with a lactobacillus
preparation. Am J Hosp Pharm 1979;36:754-757.
4 Armuzzi A, Cremonini F, Ojetti V, et al. Effect of Lactobacillus
GG supplementation on antibiotic-associated gastrointestinal side
effects during Helicobacter pylori eradication therapy: a pilot
study. Digestion 2001;63:1-7.
5 Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic
preparations on anti- Helicobacter pylori therapy-related side
effects: a parallel group, triple blind, placebo-controlled study. Am
J Gastroenterol 2002;97:2744-2749.
6 Bhatia SJ, Kochar N, Abraham P, et al. Lactobacillus acidophilus
inhibits growth of Campylobacter pylori in vitro . J
Clin Microbiol 1989;27:2328-2330.
7 Canducci F, Armuzzi A, Cremonini F, et al. A lyophilized and inactivated
culture of Lactobacillus acidophilus increases Helicobacter
pylori eradication rate. Gut 2000;47(Suppl 1):A101.
8 Al-Habbal MJ, Al-Habbal Z, Huwez FU. A double-blind controlled clinical
trial of mastic and placebo in the treatment of duodenal ulcer. Clin
Exp Pharmacol Physiol 1984;11:541-544.
9 Sivam GP, Lampe JW, Ulness B, et al. Helicobacter pylori -
in vitro susceptibility to garlic ( Allium sativum )
extract. Nutr Cancer 1997;27:118-121.
10 Ernst E. Is garlic an effective treatment for Helicobacter pylori
infection? Arch Intern Med 1999;159:2484-2485.
11 Aydin A, Ersoz G, Tekesin O, et al. Garlic oil and Helicobacter pylori
infection. Am J Gastroenterol 2000;95:563-564.
12 Kockar C, Ozturk M, Bavbek N. Helicobacter pylori eradication
with beta carotene, ascorbic acid and allicin. Acta Medica 2001;44:97-100.
13 Di Mario F, Aragona G, Bo ND, et al. Use of lactoferrin for Helicobacter
pylori eradication. Preliminary results. J Clin Gastroenterol
Dan Med Bull. 1995 Sep;42(4):374-7The Helicobacter pylori theory
and duodenal ulcer disease. A case study of the research process.
AH, Gjorup T.
Arq Gastroenterol. 2005 Jul-Sep;42(3):167-72. Epub 2005 Sep 22.
of vitamin C administration on gastric colonization by Helicobacter pylori.]
MM, Oliveira RB.
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