Infection with Helicobacter pylori (H. pylori) is a global health problem that is widespread in both industrialized and developing countries. H. pylori is a Gram-negative, spiral-shaped bacterium that prefers to colonize the human gastric mucosa and can cause various gastrointestinal diseases. These include chronic gastritis, stomach ulcers and stomach cancer.
(red) The World Health Organization (WHO) classified H. pylori as a class I carcinogen back in 1994, underlining its potentially carcinogenic effect. Worldwide, the infection rate in many countries is over 30%, in developing countries it can even reach up to 95%. One of the main problems associated with the treatment of this infection is the increasing resistance of H. pylori to common antibiotics.
The traditional therapy, known as “triple therapy”, combines proton pump inhibitors (PPI) with two antibiotics to reduce stomach acid production and eliminate the bacteria. However, increasing resistance to antibiotics such as clarithromycin and metronidazole has meant that this form of therapy is no longer sufficiently effective in many cases. In some regions, the resistance rate to clarithromycin has already reached 40%, which significantly impairs the efficacy of previous standard therapies. Against this background, the call for alternative treatment methods that cause fewer side effects and resistance problems is becoming ever louder. Two promising approaches that have been intensively researched in recent years are phytotherapy and probiotic therapy.
Phytotherapy: plant-based alternatives to antibiotics
Phytotherapy, i.e. the use of plant-based active ingredients to treat diseases, offers a promising alternative to conventional antibiotic therapy for H. pylori infections. Plant extracts have antimicrobial, anti-inflammatory and immunomodulating properties and can therefore effectively inhibit the proliferation of H. pylori . A particular advantage is that herbal active ingredients lead to less resistance and also minimize side effects compared to antibiotics.
Herbal active ingredients and their mechanisms
Plants contain a variety of bioactive compounds such as flavonoids, terpenoids, alkaloids and phenols, which are able to inhibit the growth of H. pylori. These compounds act via different mechanisms:
Inhibition of urease activity: One of the most important survival strategies of H. pylori in the acidic gastric environment is the production of the enzyme urease, which breaks down urea into ammonia and carbon dioxide and thus neutralizes the stomach acid. Herbal active ingredients such as the compounds extracted from Zingiber zerumbet (Zerumbone) inhibit the activity of urease, which considerably limits the growth of H. pylori. Inhibiting urease activity provides an effective way to fight the bacterium without affecting gastric acid production.
Anti-adhesion effect: H. pylori adheres to the epithelial cells of the stomach with the help of adhesins. Plant extracts, such as Ribes nigrum (blackcurrant) and Vaccinium macrocarpon (cranberry), contain polysaccharides that can prevent the bacterium from binding to the gastric mucosa. These polysaccharides act as competitive inhibitors by blocking the adhesion sites so that H. pylori cannot dock onto the host cells.
Oxidative stress induction: Some herbal active ingredients, such as 2-methoxy-1,4-naphthoquinone (MeONQ) isolated from Impatiens balsamina, promote the formation of reactive oxygen species (ROS), which damage the bacterium from the inside out. These compounds can interfere with the metabolism of H. pylori and trigger oxidative stress, which damages the bacterium’s cell membranes and DNA, ultimately leading to its death.
Inhibition of biofilm formation: H. pylori often forms biofilms that protect it from antibiotics and the immune system. Plant extracts such as berberine, which is obtained from the plant Coptis chinensis, can inhibit the formation of these biofilms and thus improve the effectiveness of antibiotics.
Effective plants against H. pylori
Numerous plants have already been identified that are potentially effective against H. pylori . These include:
- Garlic (Allium sativum): Contains allicin, which has antibacterial properties and can inhibit the growth of H. pylori .
- Green tea (Camellia sinensis): Polyphenols in green tea, especially epigallocatechin gallate (EGCG), have a strong inhibitory effect on the bacterium.
- Licorice (Glycyrrhiza glabra): Traditionally used to treat gastrointestinal disorders and can support the eradication of H. pylori .
- Cinnamon (Cinnamomum cassia): The essential oils contained in cinnamon have antibacterial properties and can protect the stomach lining.
Studies show that many of these plant extracts are not only effective as the sole therapy against H. pylori , but can also lead to better treatment results in combination with antibiotics.
Probiotics as a complementary therapy
In addition to phytotherapy, probiotics are a promising supplement or alternative to antibiotic therapy in the treatment of H. pylori . Probiotics are living microorganisms that positively influence the microbial balance in the digestive tract. Certain strains of lactobacilli, bifidobacteria and Saccharomyces boulardii have proven to be particularly effective against H. pylori .
Mechanisms of action of probiotics
Probiotics act against H. pylori on several levels :
Inhibition of bacterial growth: Probiotics produce antimicrobial substances such as lactic acid, which inhibit the growth of H. pylori . These substances lower the pH value in the stomach and thus create an unfavorable environment for the bacterium.
Modulation of the immune response: Probiotics can modulate the host’s immune response by increasing the production of anti-inflammatory cytokines such as IL-10 and simultaneously inhibiting pro-inflammatory cytokines such as IL-6 and TNF-α. This helps to reduce gastric mucosal inflammation, which is often triggered by H. pylori.
Prevention of adhesion: Similar to plant polysaccharides, probiotics can prevent the adhesion of H. pylori to the gastric mucosa. Studies have shown that certain strains of lactobacilli such as Lactobacillus rhamnosus and Lactobacillus plantarum can reduce the adhesion of H. pylori to the host cells by up to 70%.
Clinical results and efficacy
In clinical studies, probiotics not only improved the general well-being of patients, but also increased the eradication rate of H. pylori . In a study in which probiotics were administered in combination with standard antibiotic therapy, an eradication rate of 92% was achieved, compared to 86.8% in the control group without probiotics. Another important result was the reduction of side effects such as diarrhea and nausea, which are often associated with antibiotic treatment.
Combination of probiotics and phytotherapy
The combination of probiotics with herbal agents is also increasingly being investigated. These combination therapies could achieve synergistic effects by inhibiting both the adhesion and growth of H. pylori . For example, one study showed that the combination of fennel extract with probiotics significantly increased the efficacy against H. pylori by increasing the inhibition zone by more than 40%.
Pioneering therapeutic approaches
In addition to phytotherapy and probiotics, there are other innovative approaches to the treatment of H. pylori that are also promising:
Nanotechnological drug delivery systems: Nanoparticles, especially those based on chitosan, can transport drugs specifically to the site of infection in the stomach. This technology protects the active ingredients from being destroyed by stomach acid and prolongs their retention time in the stomach. In clinical tests, nano-based systems showed an eradication rate of up to 97% by prolonging the retention time of the active ingredients on the stomach wall.
Phage therapy: Bacteriophages, i.e. viruses that specifically infect bacteria, could represent a new, targeted therapy against H. pylori . Phages can penetrate the cell walls of bacteria and destroy them from the inside out without promoting resistance.
Lactoferrin: Lactoferrin is an iron-binding protein that can inhibit the growth of H. pylori by depriving the bacteria of the necessary iron supply. In combination with antibiotics, lactoferrin has proven to be particularly effective and could further improve the eradication rate.
Photodynamic therapy: In this new type of therapy, lasers are used to activate light-sensitive substances in the stomach. These substances release reactive oxygen species that kill H. pylori without damaging the gastric mucosa.
Conclusion
H. pylori infectionremains a global health problem that requires new therapeutic approaches due to increasing antibiotic resistance. Phytotherapy and probiotics offer promising alternatives to conventional antibiotic treatments. They act against H. pylori at different levels and have fewer side effects. Future research should focus on further optimizing these new approaches and translating them into clinical applications. In particular, the combination of phytotherapy, probiotics and innovative technologies such as nanotherapy could herald a new era in the treatment of H. pylori infections.
Source: Liu M, Gao H, Miao J, et al: Helicobacter pylori infection in humans and phytotherapy, probiotics, and emerging therapeutic interventions: a review. Front Microbiol 2024 Jan 10; 14:1330029. doi: 10.3389/fmicb.2023.1330029. PMID: 38268702; PMCID: PMC10806011.
PHYTOTHERAPY PRACTICE 2024; 1(1): 04-05 (published on 26.9.24, ahead of print)
