Abstract
The probiotic Lactobacillus rhamnosus GG (LGG) can play a role in establishing a harmless relationship with Helicobacter pylori and reduce gastric pathology in East African populations. H. pylori has the ability to inhabit the surface of the mucous layer of the human stomach and duodenum. In the developing world, an estimated 51% of the population is carrier of H. pylori, while in some Western countries these numbers dropped below 20%, which is probably associated with improved sanitation and smaller family sizes. Colonization by H. pylori can be followed by inflammation of the gastric mucus layer, and is a risk factor in the development of atrophic gastritis, peptic ulcers and gastric cancer. Notwithstanding the higher prevalence of H. pylori carriers in developing countries, no equal overall increase in gastric pathology is found. This has been attributed to a less pro-inflammatory immune response to H. pylori in African compared to Caucasian populations. In addition, a relatively low exposure to other risk factors in certain African populations may play a role, including the use of non-steroidal anti-inflammatory drugs, smoking, and diets without certain protective factors. A novel approach to the reduction of H. pylori associated gastric pathology is found in the administration of the probiotic bacterium Lactobacillus rhamnosus yoba 2012 (LRY), the generic variant of LGG. This gastro-intestinal isolate inhibits H. pylori by competition for substrate and binding sites as well as production of antimicrobial compounds such as lactic acid. In addition, it attenuates the host’s H. pylori-induced apoptosis and inflammation responses and stimulates angiogenesis in the gastric and duodenal epithelium. The probiotic LRY is not able to eradicate H. pylori completely, but its co-supplementation in antibiotic eradication therapy has been shown to relieve side effects of this therapy. In Uganda, unlike other African countries, gastric pathology is relatively common, presumably resulting from the lack of dietary protective factors in the traditional diet. Supplementation with LRY through local production of probiotic yogurt, could be a solution to establish a harmless relationship with H. pylori and reduce gastric pathology and subsequent eradication therapy treatment.
Highlights
During the last decade of our probiotic yogurt programs in the East-African countries Uganda, Tanzania, and Kenya, we took note of the high incidence of self-reported ulcers and accompanying stomach pains, as reported decades ago for in particular Northern Tanzania and South-Western Uganda and some regions in Kenya (Tovey and Tunstall, 1975; Balint, 1998)
In an intervention among 16 human subjects, a 5-day pre-treatment with a probiotic dairy product containing among others 2.4 × 109 cfu Lactobacillus rhamnosus GG (LGG) per day, has been proven to stabilize the intestinal barrier function against increased permeability normally induced by nonsteroidal anti-inflammatory drugs (NSAIDs) by 77%, thereby preventing the alterations from future pathology such as ulcers (Gotteland et al, 2001)
Kort and Sybesma (2012) and Kort et al (2015) described an intervention with the generic variant of LGG, in form of an Lactobacillus rhamnosus yoba 2012 (LRY) containing yogurt drink, which is locally produced (Westerik et al, 2016) and subsequently consumed by resource-poor communities in rural Uganda. We propose such an intervention as a preferred option to alleviate the burden of H. pylori induced pathology in resource poor communities
Summary
During the last decade of our probiotic yogurt programs in the East-African countries Uganda, Tanzania, and Kenya, we took note of the high incidence of self-reported ulcers and accompanying stomach pains, as reported decades ago for in particular Northern Tanzania and South-Western Uganda and some regions in Kenya (Tovey and Tunstall, 1975; Balint, 1998). This article reviews effects of the probiotic bacterium LGG on H. pylori colonization as well as on inflammation and associated injury of gastric mucosa, in either presence or absence of other treatments. It is expected that administration of probiotic yogurt containing LGG to children in resource-poor countries from early childhood, can reduce the incidence of H. pylori colonization in the general population.
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