Overview of the phytomedicine approaches against Helicobacter pylori

Abstract

Helicobacter pylori (H. pylori) successfully colonizes the human stomach of the majority of the human population. This infection always causes chronic gastritis, but may evolve to serious outcomes, such as peptic ulcer, gastric carcinoma or mucosa-associated lymphoid tissue lymphoma. H. pylori first line therapy recommended by the Maastricht-4 Consensus Report comprises the use of two antibiotics and a proton-pomp inhibitor, but in some regions failure associated with this treatment is already undesirable high. Indeed, treatment failure is one of the major problems associated with H. pylori infection and is mainly associated with bacterial antibiotic resistance. In order to counteract this situation, some effort has been allocated during the last years in the investigation of therapeutic alternatives beyond antibiotics. These include vaccines, probiotics, photodynamic inactivation and phage therapy, which are briefly revisited in this review. A particular focus on phytomedicine, also described as herbal therapy and botanical therapy, which consists in the use of plant extracts for medicinal purposes, is specifically addressed, namely considering its history, category of performed studies, tested compounds, active principle and mode of action. The herbs already experienced are highly diverse and usually selected from products with a long history of employment against diseases associated with H. pylori infection from each country own folk medicine. The studies demonstrated that many phytomedicine products have an anti-H. pylori activity and gastroprotective action. Although the mechanism of action is far from being completely understood, current knowledge correlates the beneficial action of herbs with inhibition of essential H. pylori enzymes, modulation of the host immune system and with attenuation of inflammation.

Keywords: Helicobacter pylori; Alternative treatment; Phytomedicine; Herbal medicine; Phytotherapy; Botanical therapy; Herb medicine; Probiotics; Antibiotic resistance

Core tip: Considering the worldwide spread of Helicobacter pylori (H. pylori) antibiotic resistance, therapeutic alternatives beyond antibiotics have been investigated during the last years, including vaccines, probiotics, photodynamic inactivation, phage therapy and phytomedicine, which are reviewed in the present paper, giving particular attention to phytomedicine. The manuscript offers an extensively referenced text about the effect of herbal medicines on H. pylori, describing the first applications of herbal medicine, passing by the category of performed studies, enumerating the tested compounds, identifying the active principle and the mode of action, and concluding with the limitations and promises of this old made new therapy.