Comparative study of Nigella Sativa and triple therapy in eradication of Helicobacter Pylori in patients with non-ulcer dyspepsia

Eyad M Salem, Talay Yar, Abdullah O Bamosa, Abdulaziz Al-Quorain, Mohamed I Yasawy, Raed M Alsulaiman, Muhammad A Randhawa, Eyad M Salem, Talay Yar, Abdullah O Bamosa, Abdulaziz Al-Quorain, Mohamed I Yasawy, Raed M Alsulaiman, Muhammad A Randhawa

Abstract

Background/aim: A large number of diseases are ascribed to Helicobacter pylori (H. pylori), particularly chronic active gastritis, peptic ulcer disease and gastric cancer. Successful treatment of H. pylori infection with antimicrobial agents can lead to regression of H. pylori-associated disorders. Antibiotic resistance against H. pylori is increasing, and it is necessary to find new effective agents. Nigella sativa seed (NS), a commonly used herb, possesses in vitro anti-helicobacter activity. The present study was undertaken to evaluate the efficacy of NS in eradication of H. pylori infection in non-ulcer dyspeptic patients.

Materials and methods: The study was conducted on 88 adult patients attending King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, from 2007 to 2008, with dyspeptic symptoms and found positive for H. pylori infection by histopathology and urease test. Patients were randomly assigned to four groups, receiving i) triple therapy (TT) comprising of clarithromycin, amoxicillin, omeprazole [n= 23], ii) 1 g NS + 40 mg omeprazole (OM) [n= 21], iii) 2 g NS + OM [n= 21] or iv) 3 g NS + OM [n= 23]. Negative H. pylori stool antigen test four weeks after end of treatment was considered as eradication.

Results: H. pylori eradication was 82.6, 47.6, 66.7 and 47.8% with TT, 1 g NS, 2 g NS and 3 g NS, respectively. Eradication rates with 2 g NS and TT were statistically not different from each other, whereas H. pylori eradication with other doses was significantly less than that with TT (P < 0.05). Dyspepsia symptoms improved in all groups to a similar extent.

Conclusions: N. sativa seeds possess clinically useful anti-H. pylori activity, comparable to triple therapy. Further clinical studies combining N. sativa with antibiotics are suggested.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Trial flow profile

References

    1. Hocker M, Hohenberger P. Helicobacter pylori virulence factors--one part of a big picture. Lancet. 2003;362:1231–3.
    1. Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clin Microbiol Rev. 2006;19:449–90.
    1. Parsonnet J. Helicobacter pylori: the size of the problem. Gut. 1998;43:S6–9.
    1. Frenck RW, Jr, Clemens J. Helicobacter in the developing world. Microbes Infect. 2003;5:705–13.
    1. Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772–81.
    1. Gerrits MM, van Vliet AH, Kuipers EJ, Kusters JG. Helicobacter pylori and antimicrobial resistance: molecular mechanisms and clinical implications. Lancet Infect Dis. 2006;6:699–709.
    1. Duck WM, Sobel J, Pruckler JM, Song Q, Swerdlow D, Friedman C, Sulka A, et al. Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States. Emerg Infect Dis. 2004;10:1088–94.
    1. Savarino V, Zentilin P, Pivari M, Bisso G, Raffaella Mele M, Bilardi C, et al. The impact of antibiotic resistance on the efficacy of three 7-day regimens against Helicobacter pylori. Aliment Pharmacol Ther. 2000;14:893–900.
    1. Wang WH, Wong BC, Mukhopadhyay AK, Berg DE, Cho CH, Lai KC, et al. High prevalence of Helicobacter pylori infection with dual resistance to metronidazole and clarithromycin in Hong Kong. Aliment Pharmacol Ther. 2000;14:901–10.
    1. Ohno T, Kita M, Yamaoka Y, Imamura S, Yamamoto T, Mitsufuji S, et al. Antimicrobial activity of essential oils against Helicobacter pylori. Helicobacter. 2003;8:207–15.
    1. Salem ML. Immunomodulatory and therapeutic properties of the Nigella sativa L. seed. Int Immunopharmacol. 2005;5:1749–70.
    1. Khan MA. Chemical composition and medicinal properties of Nigella sativa Linn. Inflammopharmacology. 1999;7:15–35.
    1. Ali BH, Blunden G. Pharmacological and toxicological properties of Nigella sativa. Phytother Res. 2003;17:299–305.
    1. Toppozada HH, Mazloum HA, el-Dakhakhny M. The antibacterial properties of the Nigella sativa l. seeds. Active principle with some clinical applications. J Egypt Med Assoc. 1965;48:299–305.
    1. Hanafy MS, Hatem ME. Studies on the antimicrobial activity of Nigella sativa seed (black cumin) J Ethnopharmacol. 1991;34:275–8.
    1. Morsi NM. Antimicrobial effect of crude extracts of Nigella sativa on multiple antibiotics-resistant bacteria. Acta Microbiol Pol. 2000;49:63–74.
    1. O’Mahony R, Al-Khtheeri H, Weerasekera D, Fernando N, Vaira D, Holton J, et al. Bactericidal and anti-adhesive properties of culinary and medicinal plants against Helicobacter pylori. World J Gastroenterol. 2005;11:7499–507.
    1. Akhtar MS, Riffat S. Field trial of Saussurea lappa roots against nematodes and Nigella sativa seeds against cestodes in children. J Pak Med Assoc. 1991;41:185–7.
    1. Bamosa AO, Ali BA, Sowayan SA. Effect of oral ingestion of Nigella sativa seeds on some blood parameters. Saudi Pharm J. 1997;5:126–9.
    1. Zaoui A, Cherrah Y, Mahassini N, Alaoui K, Amarouch H, Hassar M. Acute and chronic toxicity of Nigella sativa fixed oil. Phytomedicine. 2002;9:69–74.
    1. Badary OA, Al-Shabanah OA, Nagi MN, Al-Bekairi AM, Almazar MM. Acute and subchronic toxicity of thymoquinone in mice. Drud Develop Res. 1998;44:56–61.
    1. Hirschl AM, Makristathis A. Methods to detect Helicobacter pylori: from culture to molecular biology. Helicobacter. 2007;12:6–11.
    1. Gisbert JP, de la Morena F, Abraira V. Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:1921–30.
    1. Fraser A, Delaney BC, Ford AC, Qume M, Moayyedi P. The Short-Form Leeds Dyspepsia Questionnaire validation study. Aliment Pharmacol Ther. 2007;25:477–86.
    1. Laheij RJ, Rossum LG, Jansen JB, Straatman H, Verbeek AL. Evaluation of treatment regimens to cure Helicobacter pylori infection--a meta-analysis. Aliment Pharmacol Ther. 1999;13:857–64.
    1. Ulmer HJ, Beckerling A, Gatz G. Recent use of proton pump inhibitor-based triple therapies for the eradication of H pylori: a broad data review. Helicobacter. 2003;8:95–104.
    1. Fischbach LA, Goodman KJ, Feldman M, Aragaki C. Sources of variation of Helicobacter pylori treatment success in adults worldwide: a meta-analysis. Int J Epidemiol. 2002;31:128–39.
    1. Schwartz H, Krause R, Sahba B, Haber M, Weissfeld A, Rose P, et al. Triple versus dual therapy for eradicating Helicobacter pylori and preventing ulcer recurrence: a randomized, double-blind, multicenter study of lansoprazole, clarithromycin, and/or amoxicillin in different dosing regimens. Am J Gastroenterol. 1998;93:584–90.
    1. Peterson WL, Graham DY, Marshall B, Blaser MJ, Genta RM, Klein PD, et al. Clarithromycin as monotherapy for eradication of Helicobacter pylori: a randomized, double-blind trial. Am J Gastroenterol. 1993;88:1860–4.
    1. Higuchi K, Arakawa T, Ando K, Fujiwara Y, Uchida T, Kuroki T. Eradication of Helicobacter pylori with a Chinese herbal medicine without emergence of resistant colonies. Am J Gastroenterol. 1999;94:1419–20.
    1. Ndip RN, Malange Tarkang AE, Mbullah SM, Luma HN, Malongue A, Ndip LM, et al. In vitro anti-Helicobacter pylori activity of extracts of selected medicinal plants from North West Cameroon. J Ethnopharmacol. 2007;114:452–7.
    1. Zaidi SF, Yamada K, Kadowaki M, Usmanghani K, Sugiyama T. Bactericidal activity of medicinal plants, employed for the treatment of gastrointestinal ailments, against Helicobacter pylori. J Ethnopharmacol. 2009;121:286–91.
    1. Galan MV, Kishan AA, Silverman AL. Oral broccoli sprouts for the treatment of Helicobacter pylori infection: a preliminary report. Dig Dis Sci. 2004;49:1088–90.
    1. Bigard MA, Delchier JC, Riachi G, Thibault P, Barthelemy P. One-week triple therapy using omeprazole, amoxycillin and clarithromycin for the eradication of Helicobacter pylori in patients with non-ulcer dyspepsia: influence of dosage of omeprazole and clarithromycin. Aliment Pharmacol Ther. 1998;12:383–8.
    1. Schenk BE, Kuipers EJ, Nelis GF, Bloemena E, Thijs JC, Snel P, et al. Effect of Helicobacter pylori eradication on chronic gastritis during omeprazole therapy. Gut. 2000;46:615–21.
    1. Al Mofleh IA, Alhaider AA, Mossa JS, Al-Sohaibani MO, Al-Yahya MA, Rafatullah S, et al. Gastroprotective effect of an aqueous suspension of black cumin Nigella sativa on necrotizing agents-induced gastric injury in experimental animals. Saudi J Gastroenterol. 2008;14:128–34.
    1. Sikkema J, de Bont JA, Poolman B. Mechanisms of membrane toxicity of hydrocarbons. Microbiol Rev. 1995;59:201–22.
    1. Bolling-Sternevald E, Lauritsen K, Aalykke C, Havelund T, Knudsen T, Unge P, et al. Effect of profound acid suppression in functional dyspepsia: a double-blind, randomized, placebo-controlled trial. Scand J Gastroenterol. 2002;37:1395–402.
    1. Talley NJ, Lauritsen K. The potential role of acid suppression in functional dyspepsia: the BOND, OPERA, PILOT, and ENCORE studies. Gut. 2002;50:36–41.
    1. Kanter M, Demir H, Karakaya C, Ozbek H. Gastroprotective activity of Nigella sativa L oil and its constituent, thymoquinone against acute alcohol-induced gastric mucosal injury in rats. World J Gastroenterol. 2005;11:6662–6.
    1. El-Abhar HS, Abdallah DM, Saleh S. Gastroprotective activity of Nigella sativa oil and its constituent, thymoquinone, against gastric mucosal injury induced by ischaemia/reperfusion in rats. J Ethnopharmacol. 2003;84:251–8.

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