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Abstract

H. pylori is a gram-negative, microaerobic bacterium with a worldwide distribution in the acid – secreting gastroduodenal mucosa of man. H. pylori colonization itself is not a disease, but infection causes various clinical disorders in the upper gastrointestinal tract. Combination antibiotic therapy is advocated as its first line of treatment. But development of resistance to antibiotics, undesirable side effects and significant cost of the therapy makes it very difficult for the effective management of the condition. Moreover, compliance with the antibiotic regimen which is usually administered for 14-21 days is a big hindrance to the successful management of H. pylori. The need of the hour is to search for an alternative natural therapeutic agent which should be cost effective, devoid of undesirable side effects and must be easily available to the common people. Recent studies have suggested that H. pylori infection can be suppressed through the use of medicinal plants. In this context, recent research study reports reflect that gastro-protective medicinal plants as described in Ayurvedic Texts like Sunthi (Zingiber officinale), Rasona (Allium sativum), Kampillaka (Mallotus philipinensis), Kalajaji (Nigella sativa), Chitraka (Plumbago zeylanica), Sarpunkha (Tephrosia purpurea), Haridra (Curcuma longa), Amragandhi Haridra (Curcuma amada) and Twak (Cinnamomum spp.) possess significant anti-Helicobacter pylori activity. Therefore, it is concluded that inclusion of natural antioxidants in the normal, daily diet may be the best remedial measure for continued protection from H. pylori infection. They are nontoxic in nature and hence can be used safely.
Please cite this article as: Mishra S et al., Role of Ayurveda in the Management of Helicobacter Pylori
Infection. American Journal of Pharmacy & Health Research 2014.
Review Article
www.ajphr.com
2014, Volume 2, Issue 11
ISSN: 23213647(online)
Role of Ayurveda in the Management of Helicobacter Pylori
Infection
Manish Mishra1 , Shrutkirti Mishra*2
1.
Lecturer Department of Kaya Chikitsa, Govt. Ayurvedic College and Hospital,
Varanasi, UP, India
2. 2 Ex- Research schola,r Department of Biochemistry Institute of Medical Sciences,
Banaras Hindu University, Varanasi-221005, India
ABSTRACT
H. pylori is a gram- negative, microaerobic bacterium with a worldwide distribution in the acid
secreting gastroduodenal mucosa of man. H. pylori colonization itself is not a disease, but
infection causes various clinical disorders in the upper gastrointestinal tract. Combination
antibiotic therapy is advocated as its first line of treatment. But development of resistance to
antibiotics, undesirable side effects and significant cost of the therapy makes it very difficult for
the effective management of the condition. Moreover, compliance with the antibiotic regimen
which is usually administered for 14-21 days is a big hindrance to the successful management of
H. pylori. The need of the hour is to search for an alternative natural therapeutic agent which
should be cost effective, devoid of undesirable side effects and must be easily available to the
common people. Recent studies have suggested that H. pylori infection can be suppressed
through the use of medicinal plants. In this context, recent research study reports reflect that
gastro-protective medicinal plants as described in Ayurvedic Texts like Sunthi (Zingiber
officinale), Rasona (Allium sativum), Kampillaka (Mallotus philipinensis), Kalajaji (Nigella
sativa), Chitraka (Plumbago zeylanica), Sarpunkha (Tephrosia purpurea), Haridra (Curcuma
longa), Amragandhi Haridra (Curcuma amada) and Twak (Cinnamomum spp.) possess
significant anti- Helicobacter pylori activity. Therefore, it is concluded that inclusion of natural
antioxidants in the normal, daily diet may be the best remedial measure for continued protection
from H. pylori infection. They are nontoxic in nature and hence can be used safely.
Keywords: Helicobacter pylori, peptic ulcer, Ayurveda
*Corresponding Author Email Shrutkirti.mishra@gmail.com
Received 30 July 2014, Accepted 18 October 2014
Mishra et al., Am. J. Pharm Health Res 2014;2(11) ISSN: 2321-3647
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23
INTRODUCTION
Ulcer disease is a worldwide problem among all age groups. An ulcer is erosion in the lining of
the stomach or duodenum. Up until recently, peptic ulcer disease was thought to be caused by an
imbalance between acid and pepsin secretion, and defensive factors such as bicarbonate secretion
and gastric mucosal barrier. The isolation of Helicobacter pylori from patients with chronic
gastritis and duodenal and gastric ulcers has revolutionized thinking about the causes of peptic
ulcer disease. Over 50% of the world's population is infected; with the highest prevalence in
developing countries 1.The bacterium's spiral shape and high motility allow it to penetrate the
deep portions of the mucus gel layer, restrict gastric emptying and survive in the grooves
between epithelial cells under the protective gastric mucosal layer of the stomach. Thus, because
of the presence of this organism in ulcers, conventional treatment of peptic ulcer disease has to
be altered. At the present time, there is no generally accepted, safe and effective therapy for H.
pylori infections. Several clinical trials, using antibiotics have claimed some success. H pylori
can be eradicated by using conventional medical treatments or a natural approach.
Medical Treatment of Ulcers
The traditional medical approach to treating ulcers is with antacids, histamine-2 blockers, and
proton pump inhibitors. Antibiotics are used to kill H. pylori. Antibiotic regimens may differ
throughout the world because some strains of H. pylori have become resistant to certain
antibioticsmeaning that an antibiotic that once destroyed the bacterium is no longer effective.
Medicines that reduce stomach acid include proton pump inhibitors (PPIs) and histamine
receptor blockers (H2 blockers). Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid),
and ranitidine (Zantac) are examples of histamine-2 (H2) blockers. Proton pump inhibitors are
one of the most commonly prescribed classes of medications in the primary care setting and are
often used in the treatment of acid-peptic diseases. Since the introduction of omeprazole
(Prilosec) in 1989, several other PPIs have become available in the United States. Anti-ulcer
drugs may increase the risk of certain allergies to foods. PPIs could make it more likely to catch
an infection and the use of these ulcer drugs can increase the risk of osteoporosis. Popular ulcer
drugs such as proton-pump inhibitors that block stomach acid production heighten the risk of an
increasingly common infectious form of diarrhea. Eradication of Helicobacter pylori with
antibiotics can result in ulcer healing, prevent peptic ulcer recurrence and reduce the prevalence
of gastric cancer in high-risk populations2. But, management of H. pylori is difficult as the lining
of stomach protects them from antibiotics. Uses of single agents have been found to be
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24
ineffective for curing infection in the majority of patients. Two or three drugs for 14 to 21 days
are recommended for the treatment. But, compliance with such regimen is a big hindrance to the
successful management scheme. Development of resistance to one or more antibiotics,
undesirable side effects of the drugs and significant cost of therapy make it difficult for the
management of the condition. However it is now widely accepted that standard treatments may
only be yielding success rates of approximately 50-70%. Medical treatments do work for some
people, but they also fail for many people. As doctors continue to prescribe the same antibiotics,
H pylori resistance will continue to increase and the medications will become less and less
effective. Therefore, researchers are looking forward to find its answer from medicinal plants
which are described in Ayurvedic texts, the Indian system of medicine.
Natural Treatment of Ulcers
There are many herbs, nutrients, and plant products that have been found to play a role in
protecting or helping to heal stomach and peptic ulcers. Few human trials are available, but many
have shown good potential in animal or in vitro studies. Some important, widely-used medicinal
plants and antioxidants for treatment of H. pylori-induced gastric ulcers are discussed below
Haridra
Curcumin is a major yellow pigment of turmeric (Curcuma longa). In Ayurvedic practices, it is
known for its many medicinal properties. In South Asia, it is used as an antiseptic and anti-
inflammatory agent. Curcumin prevents the growth of CagA+ strains of H. pylori in vitro and
blocks NF-kB activation and the motogenic response in H.pylori-infected epithelial cells 3. A
study demonstrated that Curcumin and the methanol extract derived from Curcuma longa
inhibited the growth of all strains of H. pylori in vitro with a minimum inhibitory concentration
range of 6.25- 50 micrograms/ml. 4
Ginger
Ginger (Zinger officinale) has been used as a traditional source of protection against gastric
disturbances throughout history. Ginger root extracts containing the gingerols inhibit the growth
of H. pylori CagA+ strains in vitro. Active components found in ginger rhizome extract are
gingerols, which are structurally related polyphenolic compounds. Crude extract containing the
gingerols was found to be active and inhibited the growth of CagA+ strains of H. pylori with an
MIC range of 0.78 to 12.5 μg/mL 5,6. A Study shown that ginger-free phenolic and ginger
hydrolysed phenolic fractions of ginger (Zingiber officinale) acted as potent inhibitors of proton
potassium ATPase activity and H. pylori growth. 5.
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Twak
Twak or Dalchini (Cinnamomum sp.) is widely appreciated for its gastroprotective effects in
Ayurveda. In an in-vitro investigation, Ethanol and methylene chloride extracts of cinnamon
were compared for their effect on Helicobacter pylori growth and urease activity. It was
observed that, Methylene chloride extract inhibited growth of H. pylori, while ethanol extract
counteracted its urease activity. It was further observed that, cinnamon extracts were more
inhibitory on free urease than on whole cell urease 7.
Amragandhi Haridra
One study8 revealed that phenolic fractions of Curcuma amada, commonly known as mango
ginger, acted as potent inhibitors of proton potassium ATPase activity and H. pylori growth.
Kalajaji
In a very recent investigation, Salem et al., 9 reported that Kalajaji (Nigella sativa) seeds possess
clinically useful anti-H. Pylori activity comparable to conventional triple therapy
(Clarithromycin, amoxicillin, and omeprazole). H. pylori eradication was 82.6, 47.6, 66.7 and
47.8% with Triple Therapy, 1 g Nigella sativa seeds, 2 g Nigella sativa seeds and 3 g Nigella
sativa seeds, respectively. Eradication rates with 2 g Nigella sativa and Triple Therapy were
statistically not different from each other.
Sharpunkha
Chinniah et al., 10 have reported that the Apolar fractions of Sharpunkha (Tephrosia purpurea)
have promising activity against clinical isolates and standard strains of Helicobacter pylori,
including metronidazole resistant strains.
Kampillaka
Zaidi et al.,11 reported that 70% ethanolic extract of Kampillaka (Mallotus philippinensis) has
strong bactericidal activity at the concentration of 15.6-31.2 mg/l against eight H. pylori strains.
Among the isolated compounds from the extract, rottlerin exhibited most potent bactericidal
activity with minimum bactericidal concentration value of 3.12-6.25 mg/l against several clinical
H. pylori isolates including Japanese and Pakistani strains, nine clarithromycin resistant, and
seven metronidazole resistant strains.
Chitraka
Wang et al., 12 evaluated the anti-H. pylori activities of Chitraka (Plumbago zeylanica L.). They
reported that apart from the water extract, higher anti-H. pylori activity was demonstrated for all
the extracts, both using the agar diffusion and dilution methods.
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Berberine
Berberine is an alkaloid isolated from the roots and bark of several plants, including Hydrastis
canadensis, Berberis vulgaris, Berberis aristata and Anemopsis californica. It has
pronounced effect on prevention of H. pylori infection 13.
Black myrobalan
Black myrobalan (Terminalia Chebula Retz) is regarded as a universal panacea in Ayurvedic
medicine and in traditional Tibetan medicine. The antibacterial activity of aqueous extracts of
this plant against H. pylori was significantly higher than that of ether and alcoholic extracts.
Water extracts of black myrobalan (Haritaki) showed significant antibacterial activity and had a
minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of 125
and 150 mg/L, respectively 14.
Garlic
Studies have 15 indicate that garlic (Allium sativum) extract might be useful as an agent for
prevention of H. pylori-induced gastritis, leading to reduction in the risk of gastric cancer. They
investigated the effect of a garlic extract on H. pylori-induced gastritis in Mongolian gerbils. It
was observed that gram-negative H. pylori is susceptible to 40 μg/mL garlic extract 16.
Kimchi
Kimchi is prepared by fermenting cabbage. A study published in 2008 is found that this dish
contains a strain of bacteria "showing strong antagonistic activity against H. pylori" 17. The
bacterium strain isolated from kimchi, designated Lb. plantarum NO1, was found to reduce the
urease activity of H. pylori by 40-60% and suppress H. pylori’s binding to human gastric cancer
cell line by more than 33% 17.
Resveratrol
Resveratrol is a polyphenol is produced naturally in several plants, such as grape (Vitis vinifera),
peanut (Arachis hypogaea), and itadori (Fallopia japonica) root, when attacked by pathogens
such as bacteria or fungi. Resveratrol has great curative value. Many reports have suggested that
this polyphenol has protective properties against H. pylori-induced ulcers 18. In another study
antibacterial effects of extracts from red, white, black and muscadine grapes as well as the pure
compounds resveratrol, ellagic acid, and myricetin were tested for anti-H. pylori activity . The
results showed that grape extracts and their compounds were effective at inhibiting H. pylori in
vitro. Resveratrol and ellagic acid, also inhibited H. pylori 19.
Tea
Tea (Camellia sinensis) has provided new hope in the treatment of peptic ulcer and gastric
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malignancies. Many of these medicinal values of tea are attributed to its antioxidant properties.
Catechins, epigallocatechin, epicatechin gallate, epigallocatechin gallate and their oxidized
forms, such as theaflavins and thearubigins, are the compounds primarily responsible for the
antioxidative properties of green and black teas 20, 21, 22.
Helicobacter pylori infections are relatively common, affecting approximately three billion
people worldwide. The infection is interesting because of the diverse array of symptoms it
creates in different people. Some people develop only minor symptoms, or even no symptoms at
all whereas others complain of terrible stomach and chest pain, diarrhoea, bloating, nausea,
vomiting, heartburn, headaches, anxiety and rashes. Triple Therapy and Bismuth Quadruple
Therapy are well-known therapeutic measures used in eradication of H. pylori and H. pylori-
induced gastrointestinal disorders, but they often cause nausea, antibiotic resistance, recurrence
and other side effects. The ideal anti-H. pylori regimen should be safe, cheap, easy to comply
with, well tolerated by patients and able to achieve a high cure rate. Unfortunately, no such
effective appropriate regimen is available which satisfies all the above mentioned criteria.
Considering the present scenario, there is an urgent need for finding new anti-H. pylori agents
that can hopefully eradicate the invasion and presence of survived H. pylori strains to avoid
relapse of gastric ulcer. Hence, a considerable variety of studies involving tests for
gastroprotective herbs mentioned in Ayurveda against Helicobacter pylori are done. The
medicinal properties of traditional plants are attributed mainly to the presence of natural
antioxidants (mainly polyphenols and flavonoids). Several mechanisms may account for their
antioxidant activity. Flavonoids and polyphenols are efficient in trapping superoxide anion (O2-
), hydroxyl (OH·), peroxyl (ROO·) and alcohoxyl (RO·) radicals, decreasing acid mucosal
secretion, inhibiting the production of pepsinogen, promoting gastric mucosa formation and
decreasing ulcerogenic lesions 23. These herbs can be used as a substitute to convention
medications with more significant result at a lower cost to the patients. However, we want to
emphasize that research with these supplements is very new and more research work has to be
carried out to replicate these results in clinical trials.
CONCLUSION
Several natural antioxidants are able to promote healing of H. pylori-induced gastric ulcers. The
beneficial effects of these natural antioxidants are due to their ability to scavenge free radicals,
inhibiting lipid peroxidation and the generation of reactive oxygen species and reactive nitrogen
species. The natural ingredients of herbs help bring ―arogya” to human body and mind.
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28
("Arogya" means free from diseases). Ayurvedic treatment is non-invasive and non-toxic, so the
natural protocols can be used alongside conventional antibiotics or as a replacement for them.
Thus, these herbs can be used to prevent and treat deleterious morbidities of Helicobacter pylori
infection.
Conflict of Interest: The authors declare that they have no conflict of interest.
Author not has any financial relationship with the organization that sponsored the research.
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