Bismuth
subcitrate
Bismuth is a
naturally occurring mineral
antacid. It is effective at
eradicating H.pylori. Multiple
line therapy against H.pylori in
patients with peptic ulcer
disease using bismuth with a
proton-pump inhibitor and two
antibiotics, was compared against
using no bismuth. Patients were
given the treatment for 2 weeks
and the group receiving the
bismuth had a cure rate of 95%, as
opposed to the non-bismuth group
who had a cure
rate of only 62%. This study concluded
that treating H.pylori with
bismuth should be included in the
first line of treatment. [6]
Zinc
Zinc is very useful
in the treatment of peptic ulcer
disease. It has several
anti-ulcer effects that make it a
consideration in first line of
PUD therapy. First, zinc decreases the acid
output by inhibiting mast cell degranulation,
next, it has been shown to increase mucous
production and enhance the
protective barrier of cellular
membranes. Finally, zinc reduces
inflammation associated with this
condition. [7] In an analysis of 13 studies
comparing the efficacy of zinc to
an H2 blocker, zinc was shown to
be as effective at healing both
gastric and duodenal ulcers
without the side effects. [8]
Glutamine
Glutamine is a key
nutrient for intestinal structure
and function. It is considered an
essential nutrient for treatment
of peptic ulcer disease. Glutamine is
involved in the production of mucoproteins, which help form the
protective barrier in the stomach
and small intestine. In one
particular double-blind study, glutamine was
shown to accelerate the healing of peptic ulcers. [9]
Vitamin C
Vitamin C is one of
the most potent anti-oxidants. It
possesses certain anti-histamine and
anti-bacterial properties.
interestingly, levels of
vitamin C in the blood are
inversely correlated with H.pylori
infection. [10]
Also, levels of ascorbic acid in
the mucosa of individuals with
peptic ulcer disease, regardless of H.pylori status, are
often decreased. [11] In a small double-blind study, high
doses of vitamin C eradicated H.pylori infection in 30% of
patients with peptic ulcer, compared to 0% in the control
group. [12]
Vitamin A
Vitamin A is a
potent anti-oxidant. Free-radical damage is
thought to contribute to the
development of peptic ulcer
disease, regardless of H.pylori
status. Levels of carotenoids in
the mucosa of patients with peptic
ulcer disease are decreased. [13]
Supplementing with vitamin A
may help to maintain the integrity
of the mucosal barrier of the GI
tract in PUD patients.
Vitamin E
Like Vitamin A,
vitamin E is an anti-oxidant,
and aids in maintaining the integrity of the mucosal
barrier. Vitamin E is also decreased in the
mucosa of patients with peptic
ulcer disease. [14]
Poly-unsaturated
fatty acids (PUFA's)
PUFA's are
anti-oxidants that have been
shown to inhibit the growth of H.pylori in vitro. They
also have
ulcer healing properties and are
anti-inflammatory in nature. One study
that measured the levels of PUFA's in
patients with duodenal ulcers
found that levels were
significantly low and were
inversely correlated with H.pylori
infection [15]
In another small
study, patients received 2 g of
fish oil and black currant oil a
day. Participants exhibited
a 53% clearance of H.pylori in
conjunction with the resolution of
overall symptoms. [16]
Deglycyrrhizinated
licorice root (DGL)
DGL is an
anti-ulcer agent that has been
extensively studied and widely
used for peptic ulcer disease. In
study, licorice root has been
shown to stimulate mucous
formation, and prevent aspirin-induced ulceration.
Deglycyrrhizinated licorice root contains flavonoids, compounds
known to inhibit H.pylori. [17]
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