History Of Peptic Ulcer Research Articles

Limiting the Inappropriate Use of Acid Suppression Therapy for Stress Ulcer Prophylaxis in Hospitalized Patients at Cleveland Clinic Florida: A Quality Improvement Project

Introduction: The use of acid suppression therapy (AST) for stress ulcer prophylaxis (SUP) has been recommended in a specific patient population in the intensive care unit (ICU) setting. This population includes patients with mechanical ventilation longer than 48 hours, coagulopathy, multi-organ failure, shock, thermal or major trauma, neurologic trauma, and history of upper gastrointestinal (GI) bleed, peptic ulcer, or erosive gastritis in the past year. However, AST is often misused to include patients without indication for SUP. The overuse of AST increases hospital cost and potential adverse side effects. Two of the most commonly uses ASTs are proton pump inhibitors (PPIs) and H2-blockers. The main objective of this quality improvement project was to decrease the inappropriate use of PPIs and H2-blockers for SUP in patients hospitalized at Cleveland Clinic Florida (CCF). Methods: We obtained the medical records of patients prescribed (PPIs) or H2 blockers during January 2016. We performed a retrospective chart review of the January 2016 patients and explored seven data variables: admitting diagnosis, AST prescribed, route of administration, whether AST was used for treatment of prophylaxis, appropriateness of AST use for prophylaxis, appropriateness of AST use for treatment, and number of doses administered. We performed the intervention in December of 2016 by removing the “GI prophylaxis” section on the general admission order set of our electronic medical records. We then collected data looking at the same variables in inpatients who received AST in January 2017. Our primary endpoint was the rate of inappropriate use of AST. We used measures of central tendency and Pearson Chi Square testing to compare the rates of inappropriate AST use in the preintervention and post-intervention groups. Results: 365 out of 939 (36%) patients admitted during January 2016 inappropriately received AST with PPIs or H2-blockers for SUP. In the post-intervention period (January 2017), 243 out of 945 (25.7%) patients received inappropriate PPIs or H2-blockers for SUP. This was statistically significant (p value <.0001). Conclusion: Acid suppression therapy for stress ulcer prophylaxis is frequently misutilized in hospitalized patients. This increases hospital costs and adverse events. More interventions should be performed to ensure the appropriate use of SUP, which would decrease resource expenditures without negatively impacting the quality of care patients receive.1097 Figure 1 No Caption available.

Dietary habits and Helicobacter pylori infection: a cross sectional study at a Lebanese hospital

BackgroundTo examine the association between dietary habits and Helicobacter pylori (H. pylori) infection among patients at a tertiary healthcare center in Lebanon.MethodsThis cross-sectional study was conducted on 294 patients in 2016, at a hospital in Northern Lebanon. Participants were interviewed using a structured questionnaire to collect information on socio-demographic and lifestyle characteristics; dietary habits were ascertained via a short food frequency questionnaire (FFQ). H. pylori status (positive vs. negative) was determined after upper GI endoscopy where gastric biopsy specimens from the antrum, body, and fundus region were collected and then sent for pathology analysis. Multivariable logistic regression was conducted to identify the association between socio-demographic, lifestyle, dietary and other health-related variables with H pylori infection.ResultsThe prevalence of H. pylori infection was found to be 52.4% in this sample. Results of the multivariable analysis showed that H. pylori infection risk was higher among participants with a university education or above (OR = 2.74; CI = 1.17–6.44), those with a history of peptic ulcers (OR = 3.80; CI = 1.80–8.01), gastric adenocarcinoma (OR = 3.99; CI = 1.35–11.83) and vitamin D level below normal (OR = 29.14; CI = 11.77–72.13). In contrast, hyperglycemia was protective against H. pylori (OR = 0.18; CI = 0.03–0.89). No relationship between dietary habits and H. pylori infection was found in the adjusted analysis.ConclusionsSocio-demographic and clinical variables are found to be associated with H. pylori, but not with dietary factors. Further studies are needed to investigate the effect of diet on H. pylori risk.

The Impacts of Peptic Ulcer on Stroke Recurrence

Peptic ulcer has been associated with an increased risk of stroke. This study aimed to evaluate the impacts of peptic ulcer on stroke recurrence and mortality. Patients with first-ever ischemic stroke were retrospectively confirmed with or without a history of peptic ulcer. The primary end point was defined as fatal and nonfatal stroke recurrence. Risks of 1-year fatal and nonfatal stroke recurrence were analyzed with the Kaplan-Meier method. Predictors of fatal and nonfatal stroke recurrence were evaluated with the Cox proportional hazards model. Among the 2577 enrolled patients with ischemic stroke, 129 (5.0%) had a history of peptic ulcer. The fatal and nonfatal stroke recurrence within 1 year of the index stroke was higher in patients with peptic ulcer than in patients without peptic ulcer (12.4% versus 7.2%, P = .030). Cox proportional hazards model detected that age (hazard ratio [HR] = 1.018, 95% confidence interval [CI] 1.005-1.031, P = .008), hypertension (HR = 1.397, 95% CI 1.017-1.918, P = .039), and history of peptic ulcer (HR = 1.853, 95% CI 1.111-3.091, P = .018) were associated with stroke recurrence. Ischemic stroke patients with peptic ulcer may have an increased risk of stroke recurrence. The results emphasize the importance of appropriate prevention and management of peptic ulcer for secondary stroke prevention.

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Recent concerns have been raised about the potential for proton pump inhibitors (PPIs) to blunt the efficacy of clopidogrel. We observed the effect of clopidogrel plus aspirin with or without omeprazole in patients with carotid stenoses after they received placement of carotid stents. Sixty-four consecutive patients treated with percutaneous carotid artery stenting (CAS) comprised the sample. All enrolled patients underwent the C13 urea breath test (C13 UBT) before CAS. Patients with Helicobacter pylori infection and a history of peptic ulcer were assigned dual antiplatelet combination with omeprazole. Others received dual antiplatelet without omeprazole. Transcranial Doppler and ultrasonography were performed to assess the middle cerebral artery and carotid artery in follow-up at three months and six months. Eight patients had gastrointestinal bleeding; the event rate was 22.6% without omeprazole and 3.8% with omeprazole. The rate of gastrointestinal bleeding was reduced with omeprazole as compared without omeprazole (p = 0.026, p < 0.05). The two groups did not differ significantly in the rate of in-stent restenosis and thrombus through transcranial Doppler and ultrasonography. Among patients receiving dual antiplatelet therapy, prophylactic use of omeprazole reduced the rate of upper gastrointestinal bleeding. There was no apparent interaction between clopidogrel and omeprazole in patients with carotid artery stenting.

Do stop me now: gastric acid-reducing drugs following renal transplantation

Proton pump inhibitors (PPIs) can counteract the risk of gastrointestinal bleeds, but can also be harmful. University Hospitals Coventry and Warwickshire NHS Trust's renal transplant drug protocol recommends that patients take omeprazole if they have a history of peptic ulcers or indigestion. Ines Held and Rhodri Pyart share the findings of two audits on PPIs in renal transplant patients.

Influence of working in auto factory on gastroesophageal reflux disease.

Present study aimed to evaluate association between job -related factors and gastroesophageal reflux disease (GERD) among Iranian auto factory's workers. Many of the gastrointestinal disorders may be caused as the result of stress-related occupations and biorhythm disruption. We performed a cross-sectional study on 3590 Iranian Auto factory employees. GERD symptoms, demographic information, work shift, work section and history of some gastrointestinal disease were asked from all employees by physician. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for GERD symptoms according to the potential risk factors. The prevalence of GERD was 25.57%, which was higher in rotatory shift (91.6%) than the fixed shift (8.4%) (P-value = 0.009). Smoking (OR: 1.31; 95% CI: (1.09, 1.57)), working in official section (P-value < 0.001), history of GERD (OR: 8.63; 95 % CI (6.53, 11.40)), history of peptic ulcer (OR: 2.96; 95 % CI (2.08, 4.20)), family history of gastrointestinal cancers (OR: 1.47; 95 % CI (1.19, 1.81)) were the factors associated with GERD symptoms. The prevalence of GERD in the rotatory shift was more than the fixed shift. Smoking, family history of gastrointestinal cancers and peptic ulcer could be associated with GERD symptoms. Working in the special job with high activity, may probably lead to decrease in the risk of reflux.

Пілоротрансверзальна нориця, як ускладнення виразкової хвороби шлунка

Aim.&nbsp;Improving the diagnosis and treatment of multiple complications of peptic ulcer. Materials and Methods. Retrospective analysis of clinical signs, results of laboratory, instrumental examinations and surgical treatment of multiple peptic ulcer complications in a 54-year-old patient H., who was treated at the Department of Surgery №2 of Lviv Regional Clinical Hospital. Results and Discussion.&nbsp;In a 54-year-old patient with 20 years history of peptic ulcer, a combined complication developed: decompensated pyloric stenosis, penetration of gastric ulcers to the transverse colon with formation of a gastro-colic fistula, which was confirmed only at contrast CT of abdominal cavity. These complications led to severe disturbance of fluid-electrolyte and acid-base balance. After the correction of fluid-electrolyte and acid-base balance, a one-stage operation was performed - the Billroth II resection of the stomach with gastro-enterostomy on a short loop, and transverse colon resection with end-to-end anastomosis. Conclusions.&nbsp;Verification of diagnosis in patients with peptic ulcers with multiple complications needs advanced diagnostic procedures. Combination of gastric outlet obstruction and penetration of peptic ulcer to the transverse colon with fistula formation lead to significant disturbances of water-electrolyte and acid-base balance. Simultaneous operation (Billroth II gastric resection and resection of the transverse colon with end-to-end anastomosis) is possible after thorough correction of fluid-electrolyte and acid-base balance.

Vonoprazan prevents low-dose aspirin-associated ulcer recurrence: randomised phase 3 study

ObjectiveCompare efficacy and safety of vonoprazan and lansoprazole for secondary prevention of low-dose aspirin (LDA)-associated peptic ulcers in a 24-week study and long-term extension therapy in separate study.DesignDouble-blind, randomised, non-inferiority...

Efficacy and tolerability of culture-guided treatment for Helicobacter pylori infection.

The aim of this study was to evaluate the efficacy/tolerability of a culture-guided approach in the eradication of Helicobacter pylori and identify factors associated with antibiotic resistance/treatment failure. This retrospective single-center study included patients who underwent culture-guided treatment for H. pylori infection, after two ineffective eradication attempts, between October 2012 and December 2016. We assessed the following demographic and clinical data of the patients: sex, age, BMI, alcohol and tobacco consumption, history of dyspepsia, peptic ulceration and first-degree relatives with gastric cancer, antibiotic susceptibility results, treatment composition, tolerability, and success. The treatment success was confirmed by a monoclonal stool antigen test. Culture-guided treatment was performed in 42 patients (57% women, mean age±SD: 48.9±11.4 years). The rates of antibiotic resistance were as follows: clarithromycin 86%, metronidazole 67%; levofloxacin 52%, tetracycline 2%, and amoxicillin and rifampicin 0%. Double resistance to clarithromycin and metronidazole was found in 59.5% of the patients. Most patients showed resistance to less than three antibiotics, but 31% were resistant to three or more. Intention-to-treat and per-protocol eradication rates were 59.5 and 61.5%. Adverse events occurred in 15 (35.7%) patients, but only two (4.8%) patients did not complete treatment because of adverse events. Only age more than 50 years was associated with resistance to three or more antibiotics. Having a first-degree relative with gastric cancer was associated with treatment failure and having a BMI of at least 25 kg/m protected from failure. Third-line culture-guided treatment often fails to eradicate H. pylori infection. We need to find factors other than in-vitro antibiotic resistance to explain these suboptimal results.

O59-2 - Associations between Proton Pump Inhibitors and Low Cardiac Mortality in Patients with Heart Failure

Background: It has been recently reported that use of histamine H2 receptor blocker (H2RA) reduces risk of incident heart failure (HF). However, the association between acid suppressive therapy such as H2RA or proton pump inhibitor (PPI) and cardiac mortality in HF patients is still unclear. Methods and Results: Consecutive 1191 HF patients were divided into 3 groups: no acid suppressive therapy group (n = 363), H2RA group (n = 164) and PPI group (n = 664). Although presence of male gender, atrial fibrillation and reduced left ventricular ejection fraction did not differ among the three groups, prevalence of ischemic etiology, dyslipidemia, anemia and past history of peptic ulcer was higher in PPI group than in H2RA and no acid suppressive therapy groups (ischemic etiology: 32.2, 27.4 and 15.7%, P < .001; dyslipidemia: 79.2, 77.4 and 70.5%, P = .007; anemia: 64.0, 54.3 and 46.0%, P < .001; peptic ulcer: 15.1, 7.9 and 6.3%, P < .001). In the Kaplan-Meier analysis, cardiac mortality was significantly lower in PPI group than in the other groups (P < .05). In the multivariable Cox proportional hazard analysis after adjusting for other potential confounding factors, use of PPI, but not H2RA, was an independent predictor of cardiac mortality in HF patients (PPI, HR 0.475, P < .001; H2RA, HR 0.968, P = .881). Conclusion: PPI may be associated with better outcome in patients with heart failure.

E‐Poster Presentations – A2) Gastric and Duodenal

E‐Poster Presentations – A2) Gastric and Duodenal

Azithromycin and risk of COPD exacerbations in patients with and without Helicobacter pylori

BackgroundHelicobacter pylori (HP) infection is associated with reduced lung function and systemic inflammation in chronic obstructive pulmonary disease (COPD) patients. Azithromycin (AZ) is active against HP and reduces the risk of COPD exacerbation. We determined whether HP infection status modifies the effects of AZ in COPD patients.MethodsPlasma samples from 1018 subjects with COPD who participated in the Macrolide Azithromycin (MACRO) in COPD Study were used to determine the HP infection status at baseline and 12 months of follow-up using a serologic assay. Based on HP infection status and randomization to either AZ or placebo (PL), the subjects were divided into 4 groups: HP+/AZ, HP-/AZ, HP+/PL, and HP-/PL. Time to first exacerbation was compared across the 4 groups using Kaplan-Meier survival analysis and a Cox proportional hazards model. The rates of exacerbation were compared using both the Kruskal-Wallis test and negative binomial analysis. Blood biomarkers at enrolment and at follow-up visits 3, 12, and 13 (1 month after treatment was stopped) months were measured.ResultsOne hundred eighty one (17.8%) patients were seropositive to HP. Non-Caucasian participants were nearly three times more likely to be HP seropositive than Caucasian participants (37.4% vs 13.6%; p < 0.001). The median time to first exacerbation was significantly different across the four groups (p = 0.001) with the longest time in the HP+/AZ group (11.2 months, 95% CI; 8.4–12.5+) followed by the HP-/AZ group (8.0 months, 95% CI; 6.7–9.7). Hazard ratio (HR) for exacerbations was lowest in the HP+/AZ group after adjustment for age, sex, smoking status, ethnicity, history of peptic ulcer, dyspnea, previous hospital admission, GOLD grade of severity, and forced vital capacity (HR, 0.612; 95% CI, 0.442–0.846 vs HR, 0.789; 95% CI, 0.663–0.938 in the HP-/AZ group). Circulating levels of soluble tumor necrosis factor receptor-75 were reduced only in the HP+/AZ group after 3 months of AZ treatment (−0.87 ± 0.31 μg/L; p = 0.002); levels returned to baseline after discontinuing AZ.ConclusionsAZ is effective in preventing COPD exacerbations in patients with HP seropositivity, possibly by modulating TNF pathways related to HP infection.

Histamine-2 Receptor Antagonist Cannot Prevent Recurrent Peptic Ulcers in Patients With Atherosclerotic Diseases Who Receive Platelet ADP Receptor Antagonist Monotherapy: A Randomized-Controlled, Double-Blind, and Double-Dummy Trial.

Proton pump inhibitor can effectively prevent recurrent peptic ulcers among atherosclerotic patients receiving clopidogrel monotherapy. However, the interaction between proton pump inhibitors and clopidogrel has raised concerns over the safety of combined use of the two medicines in clinical practice. The aims of this randomized-controlled, double-blind and double-dummy trial were to investigate the efficacy of histamine-2 receptor antagonist (H2RA) in the prevention of recurrent peptic ulcer in patients undergoing thienopyridine monotherapy. From January 2012 to 2016, long-termed thienopyridine users with a peptic ulcer history who did not have peptic ulcers at initial endoscopy were randomly assigned to receive either famotidine (40 mg, before bedtime) or placebo (before bedtime) for 6 months. Follow-up endoscopy was performed at the end of the 6th month and whenever dyspepsia, hematemesis, or melena occurred. The cumulative incidence of recurrent peptic ulcer during the 6-month period was 7.0% in famotidine group (n=114) and 11.4% in the placebo group (n=114). The two patient groups had comparable cumulative incidence of peptic ulcer (difference, 4.4%; 95% confidence interval (CI), -11.7 to 2.9%; P=0.239). Additionally, there was no difference in the cumulative incidence of ulcer bleeding (2.6% vs. 1.8%; difference, 0.8%; 95% CI, -0.6 to 2.4%, P=1.000) between famotidine and placebo groups. However, the former had a lower incidence of gastroduodenal erosion than the latter (21.1% vs. 36.8%; difference, 15.7%; 95% CI, -27.3 to -4.1%; P=0.013). Famotidine cannot decrease the incidence of peptic ulcer or ulcer bleeding in thienopyridine users with atherosclerotic disease and a history of peptic ulcer.

Cross-sectional analysis of retrospective case series of hospitalisations for gastropathy caused by non-steroidal anti-inflammatory treatment: risk factors and gastroprotection use

ObjectivesTo analyse the risk factors of gastropathy caused by using non-steroidal anti-inflammatory drugs (NSAIDs) in detected hospital admissions and to analyse the use of gastroprotective treatment concerning these risk factors.MethodsA...

Analysis of the cost-effectiveness of using vonoprazan–amoxicillin–clarithromycin triple therapy for first-line Helicobacter pylori eradication

Background: Vonoprazan (VPZ)-based triple therapy has been reported to have greater efficacy than a proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) eradication. However, because VPZ is more expensive than PPIs such as rabeprazole (RPZ), economic evaluation is essential.Methods: We performed a retrospective study on 209 patients who underwent first-line eradication of H. pylori infection in Fuyoukai Murakami Hospital from 1 March 2015 to 31 March 2016. Patients who received VPZ, amoxicillin (AMPC) and clarithromycin (CAM) were assigned to the VPZ/AC group (n = 111) and patients who received RPZ, AMPC and CAM to the RPZ/AC group (n = 98). We compared the patients’ backgrounds, including age, gender, use of high-dose CAM, past history of peptic ulcer, smoking and drug-related adverse events between the two groups. We defined cost as direct medical costs per patient and effectiveness as the first-line eradication rate in the intention-to-treat (ITT) analysis and analyzed the cost-effectiveness using the cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER).Results: There was no significant difference in the patients’ backgrounds. The ITT analysis revealed an eradication rate of 94.6% for VPZ/AC and 86.7% for RPZ/AC. VPZ/AC cost 1155.4 Japanese yen (JPY) higher than RPZ/AC (34063.4 vs. 32908.0, JPY). CER of VPZ/AC was less than that of RPZ/AC (360.1 vs. 379.4, JPY per percent) and ICER of VPZ/AC was 147.0 JPY (1.28 Euro (EUR), 1 EUR =115 JPY) per percent.Conclusions: VPZ/AC was more cost-effective than RPZ/AC as first-line therapy for H. pylori eradication.

Severe gastrointestinal bleeding due to erlotinib and celecoxib therapy: additional effect?

Non-small cell lung cancer (NSCLC) is the leading cause of cancer related dead worldwide and account for over 85% of all lung cancers. Furthermore, the majority of patients with NSCLC present with advanced, metastatic disease at the time of diagnosis. For most patients with non-small cell lung cancer, current treatments do not cure the cancer. Therefore, there is a great need for development of more effective therapies. The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) like erlotinib and gefitinib have been recognized as an important molecular target in cancer therapy and they are approved for the treatment of refractory advanced NSCLC patients. EGFR TKIs are generally well tolerated. The two most common toxicities include dermatologic and gastrointestinal side effects. Cases of gastrointestinal perforation, some of which were fatal, have also been reported in patients receiving erlotinib. Those at increased risk include those taking concomitant anti-angiogenic agents, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or taxane-based chemotherapy, or who have prior history of peptic ulceration or diverticular disease.

Evaluation of factors in a primary care setting which may cause failure to respond to oral iron treatment in iron deficiency anaemia patients

Objective The purpose of this study was to evaluate therapeutic outcomes in patients treated for iron deficiency anaemia and to analyse potential factors relevant to therapy success or failure. Methods Adult iron deficiency anaemia patients attending a primary care centre and prescribed at least 80 mg elemental iron per day were enrolled and followed up after duration of at least 5–8 weeks. Factors relevant to therapy success or failure were investigated. Results One hundred and seven patients were interviewed and 65 patients provided blood samples at follow-up. Thirty-seven patients (56.9%) were found refractory to iron therapy. More than half of patients reported having iron-related side effects (56.9%). Almost half of patients (47.7%) stated that they stopped iron therapy sometime during their follow-up period. Thirty patients (46.2%) stated that pharmacist educated them about iron therapy indication and usage and three patients (4.6%) stated that pharmacist educated them about drug–drug and drug–food interactions. Conclusion Response to iron therapy was suboptimal. There was no correlation between response to iron therapy and other studied factors such as gastrointestinal side effects, menstrual cycle history, past medical history of peptic ulcer, celiac disease or level of iron therapy education provided to patients.

Are the clinical guideline recommendations on gastroprotection being followed? A review in patients taking nonsteroidal anti-inflammatory drugs

Introduction and aimsThe chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause complications in the gastrointestinal tract. The use of proton pump inhibitors (PPIs) is recommended in high-risk patients to prevent them. ObjectiveThe aim of this article was to evaluate the gastroprotection measures taken in persons with chronic NSAID use. Materials and methodsA descriptive cross-sectional study was conducted. The clinical records were reviewed of patients seen as outpatients at the Rheumatology Department over a 4-month period, choosing those with chronic NSAID use, and intentionally looking for gastroprotection measures according to the recommendations published by the American College of Gastroenterology. ResultsA total of 417 patients (347 women; mean age: 48.12±14.2 years) were included. The most frequent diagnosis was rheumatoid arthritis (65%). Nine patients (2.1%) had a history of peptic ulcer, 48 (11.5%) patients were 65 years of age or older, 26 (6.2%) patients took NSAIDs and aspirin, and 130 (31.2%) took NSAIDs with steroids. Tests for Helicobacter pylori infection were done in just 53 cases, and there were positive results in only 9 (16%). Some risk for gastrointestinal toxicity was established in 211 cases and only 65 (30.8%) received gastroprotection. In contrast, 31 (15%) patients received gastroprotection when there was no indication for it. ConclusionProphylaxis with PPIs in chronic NSAID users was inadequately employed. It was not prescribed in the majority of patients (69.2%) and it was used with no justification in others (15%).

Are the clinical guideline recommendations on gastroprotection being followed? A review in patients taking nonsteroidal anti-inflammatory drugs.

The chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause complications in the gastrointestinal tract. The use of proton pump inhibitors (PPIs) is recommended in high-risk patients to prevent them. The aim of this article was to evaluate the gastroprotection measures taken in persons with chronic NSAID use. A descriptive cross-sectional study was conducted. The clinical records were reviewed of patients seen as outpatients at the Rheumatology Department over a 4-month period, choosing those with chronic NSAID use, and intentionally looking for gastroprotection measures according to the recommendations published by the American College of Gastroenterology. A total of 417 patients (347 women; mean age: 48.12±14.2 years) were included. The most frequent diagnosis was rheumatoid arthritis (65%). Nine patients (2.1%) had a history of peptic ulcer, 48 (11.5%) patients were 65 years of age or older, 26 (6.2%) patients took NSAIDs and aspirin, and 130 (31.2%) took NSAIDs with steroids. Tests for Helicobacter pylori infection were done in just 53 cases, and there were positive results in only 9 (16%). Some risk for gastrointestinal toxicity was established in 211 cases and only 65 (30.8%) received gastroprotection. In contrast, 31 (15%) patients received gastroprotection when there was no indication for it. Prophylaxis with PPIs in chronic NSAID users was inadequately employed. It was not prescribed in the majority of patients (69.2%) and it was used with no justification in others (15%).

Combination of Nigella sativa and Honey in Eradication of Gastric Helicobacter pylori Infection.

BackgroundGastric Helicobacter pylori is extremely common worldwide.ObjectivesThe aim of this study was to assess the effectiveness of combination of Nigella sativa and honey (Dosin) in eradication of gastric H. pylori infection.Patients and MethodsNineteen patients who had positive result for H. pylori infection by urea breath test (UBT) without a past history of peptic ulcer, gastric cancer or gastrointestinal bleeding, were suggested to receive one teaspoon of the mixture of Dosin (6 g/day of N. sativa as ground seeds and 12 g/day of honey) three times a day after meals for two weeks. The second UBT was used to detect the presence of H. pylori four weeks after completion of the test. In addition, symptoms of dyspepsia were scored before and after the study and analyzed with Wilcoxon signed-rank test.ResultsFourteen patients completed the study. Negative UBT was observed in 57.1% (8/14) of participants after intervention. The median and interquartile range (IQR) of total dyspepsia symptoms was significantly reduced from 5.5 (5 - 12) to 1 (0 - 4) (P = 0.005). All the patients tolerated Dosin except for one who was excluded due to mild diarrhea. No serious adverse events were reported.ConclusionsDosin was concluded to be an anti H. pylori and an anti-dyspeptic agent. Further studies are recommended to investigate the effect of Dosin plus antibiotics (concurrently or following another) on gastric H. pylori infection.