Helicobacter Pylori, Triple Therapy and Cranberry Juice Itzhak Ofek, Ph.D. Haim Shmuely, M.D. "Effect of Cranberry Juice on Eradication of Helicobacter Pylori in Patients Treated with Antibiotics and a Proton Pump Inhibitor," Mol Nutr Food Res, 2007; 51(6): 746-51. 45464 (9/2007) Kirk Hamilton: Can you please share with us your educational background and current position? Haim Shmuely, MD: Deputy Chief , Department of Internal Medicine C, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel. Senior Consultant in Infectious Diseases. Lecturer at Tel Aviv University , Sackler Faculty of Medicine. Visiting scholar and visiting professor at the Infectious Disease Unit, Stanford University School of Medicine, Stanford Medical Center, California, USA. Main research interest is H. pylori infection and associated diseases. Itzhak Ofek, PhD: Professor of Microbiology, Department of Human Microbiology, Sackler Faculty of Medicine, Tel Aviv University. PhD obtained at Hadassha Medical School, Hebrew University, Jerusalem in medical microbiology. Joined the faculty of Tel Aviv University in 1979. Interested in anti-adhesion therapy of bacterial infectious diseases. KH: What got you interested in studying the role of cranberry juice in H. pylori eradication? HS & IO: This collaborative research on cranberry and H. pylori eradication stem from the involvement of one of us (H.S.) as part of a team in Rabin Medical Center interested in H. pylori infections on one hand and the involvement of the other (I.O.) as part of a cranberry team interested in various biological activities of cranberry components and especially in their anti- adhesion activities. Initially we performed in vitro studies involving a PhD student to test the susceptibility of H. pylori isolates to the anti-adhesion effect of a high molecular weight component of cranberry. When we found that about two thirds of the isolates were susceptible to the anti-adhesion activity of the cranberry material, we decided to perform the clinical study described in the Journal of Molecular Nutrition and Food Research. KH: What are the biological components of cranberry juice that exert a beneficial or anti-infective effect on H. pylori? HS & IO: There are two components implicated to be responsible for the anti-adhesion activity of cranberry. One component acts mainly against uropathogenic E.coli and was described by a group of investigators in Rutgers University as protoanthocyanidins. The other component, acts against several pathogenic bacterial species, described by the Israeli Cranberry Team as a high molecular weight, non-dialyzable material, termed NDM. The latter may be a polymer of phenol-containing oligomers but its exact structure has not been yet defined. KH: Why did you use cranberry juice versus a cranberry extract? Was there a special type of juice that you used? Where did you come up with the dose of 250 ml twice daily? Was it given with meals or away from meals? HS & IO: Cranberry juice cocktail sold in supermarkets is recommended at the indicated dosage per Cochrane Database Systematic Review for the treatment of urinary tract infections. We simply adhered to this regime. Our patients were instructed to consume the cranberry juice after meals with the antibiotic triple therapy for the first week and continue to consume only cranberry juice for the next two weeks. KH: Can you tell us about your study and the basic results? HS & IO: We treated all our patients with the standard triple therapy for H.pylori including omeprazole, amoxicillin and clarithromycin (OAC) for one week. One group of patients, non-placebo group, included patients admitted at the same time and received only triple antibiotic treatment. The other group was included in a double-blind randomized clinical study, whereby the patients were given in addition to the triple therapy 250 ml boxes containing either cranberry juice cocktail or placebo beverage. After the first week of treatment with the antibiotics and cranberry or placebo beverage, the patients continued to consume only cranberry or placebo beverage for two more weeks. Initial analysis revealed that there was no significant difference between the cranberry and placebo groups in the percent eradication of H. pylori being about 80% to 85%. However, when the data were analyzed by gender, 42 females responded in significantly higher percent of eradication up to 95% as compared to 86.5% in the 53 females in the placebo arm or to 80% in the 425 nonplacebo female group. No such difference was noted in males. These results suggest that the addition of cranberry to triple therapy improves the rate of H. pylori eradication in females. KH: Were there any side effects to the cranberry juice? How was the patient? Compliance? HS & IO: No serious adverse effect occurred and in general compliance was satisfactory. KH: Is there any reason not to give cranberry juice to all H. pylori patients undergoing triple therapy? HS & IO: We do recommend cranberry juice to females only at this stage and yes for every female patient infected with H.pylori and undergoing triple therapy. KH: Do you think the addition of cranberry juice may be able to reduce the strength and duration of some of the pharmaceutical medications? HS & IO: Not that we know of. KH: Do you have any comment on the role of vitamin C and H. pylori eradication? I have seen research on low levels of ascorbic acid in gastric juice being associated with an increased incidence of H. pylori infection? HS & IO: Adding vitamin C to one-week triple therapy can reduce the dosage of clarithromycin, but preserve the high eradication efficacy of clarithromycin- susceptible H. pylori. Serum ascorbic acid levels were not significantly associated with H. pylori serology among non-whites whereas higher serum levels of ascorbic acid were found to be associated with a decreased seroprevalence of H. pylori and of the pathogenic cagA-positive strains of H. pylori among whites. These associations may be related causally and are not the result of residual confounding factors such as socioeconomic status. Thus, ascorbic acid may affect the risk of H. pylori infection and in turn, the risk for peptic ulcer disease and gastric cancer among white Americans and vitamin C supplementation may protect against progression of gastric mucosal atrophy. KH: Do you have any thoughts on why cranberry juice might improve the eradication of H. Pylori in females but not in males? HS & IO: This is a difficult question to answer at this stage of research. This study and a few others suggest that H.pylori-host interactions are gender associated. There are a number of possibilities that comes to mind. For example the retention or fate of the anti-adhesion cranberry material may be gender associated or the underlying mechanism of H.pylori adhesion to female tissues is different from those to males in a manner to allow the cranberry material to inhibit the former but not the latter. Further studies are required to test which of these or other hypotheses explain such remarkable gender associated differences. KH: Do you have any further comments you would like to make on this very interesting subject? HS & IO: We think that the next step should substantiate our findings employing large number of females only, and this time to culture the bacteria and simultaneously test the isolates in vitro for susceptibility to the antibiotic and to the anti-adhesion effect of cranberry. Helicobacter Pylori Research Institute Rabin Medical Center, Beilinson Campus Petah Tikva, Tel Aviv University Tel Aviv, Israel 972-542320366 aofek@post.tau.ac.il Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.