A curcumin-based 1-week triple therapy for eradication of Helicobacter pylori infection: something to learn from failure?
BACKGROUND
Curcumin is the principal element of turmeric powder extracted from the root of Curcuma longa. Studies on curcumin have demonstrated some anti-Helicobacter pylori activity as well as immunomodulating properties. N-acetylcysteine and lactoferrin with their respective mucolytic and antibacterial activities might also be effective in H. pylori eradication therapy.


OBJECTIVE
To determine if a 7-day non-antibiotic therapy comprised of curcumin, lactoferrin, N-acetylcysteine, and pantoprazole was effective for eradication of H. pylori infection and reduction of gastric inflammation, assessed by serum pepsinogens and relief of symptoms.


METHODS
Twenty-five consecutive H. pylori-positive patients (12 males, mean age 50 +/- 12 years, range 31-76) with functional dyspepsia were enrolled. Patients were administered for 7 days curcumin 30 mg b.i.d., bovine lactoferrin 100 mg b.i.d., N-acetylcysteine 600 mg b.i.d., and pantoprazole 20 mg b.i.d. H. pylori status and upper gastrointestinal symptoms were assessed by (13)C-urea breath test and a scale of upper gastrointestinal symptoms intensity (absent, mild, moderate, and severe), as well as a blood test for serum pepsinogens (sPGI, sPGII), gastrin-17 (G-17), and anti-H. pylori IgG (IgG-Hp) at baseline (T0) and after 2 months (T1).


RESULTS
Three of 25 patients (12%) were cured of H. pylori infection. A significant decrease in the overall severity of symptoms (T0: 6, interquartile range [IQR]: 4.5-8; T1: 2, IQR: 2-3; p < or = .001), and sPGII (T0: 16 microg/L, IQR: 13-22; T1: 10 microg/L, IQR: 8-16; p < or = .001) and sPGI (T0: 82 microg/L, IQR: 67-97; T1: 74 microg/L, IQR: 62-94; p = .02) levels were observed after 2 months of the treatment. IgG and G-17 values did not significantly decrease after 2 months.


CONCLUSIONS
This novel therapy was not effective for H. pylori eradication. However, despite the bacterium persistence, significant improvement of dyspeptic symptoms and reduction of serologic signs of gastric inflammation were observed after 2 months at the end of the 7-day treatment schedule.
Di Mario
Francesco
F
Section of Gastroenterology, Department of Clinical Sciences, University of Parma, Italy. francesco.dimario@unipr.it
Cavallaro
Lucas G
LG
Nouvenne
Antonio
A
Stefani
Nicoletta
N
Cavestro
Giulia M
GM
Iori
Veronica
V
Maino
Marta
M
Comparato
Giuseppe
G
Fanigliulo
Libera
L
Morana
Ester
E
Pilotto
Alberto
A
Martelli
Laura
L
Martelli
Mario
M
Leandro
Gioacchino
G
Franzè
Angelo
A
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000111:Acetylcysteine / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003474:Curcumin / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D007781:Lactoferrin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D017211:Treatment Failure
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000077402:Pantoprazole; D007781:Lactoferrin; D003474:Curcumin; D000111:Acetylcysteine