20 februari 2020: Ook een nieuwe gerandomiserde placebo gecontroleerde studie bevestigt dat wanneer mensen waarvan in hun directe familie (ouders, kinderen) bekend is dat deze besmet zijn geweest met de Helicobacter pylori bacterie en daardoor maagkanker hadden gekregen en nu bij hun zelf actief de H. pylori bacterie werd bestreden en gedood dan hebben zij meer dan de helft minder risico (1,2 versus 2,7 procent) op het ontstaan van maagkanker binnen 9 jaar. Wat logisch is want de Heliobacter Pylori bacterie is voor een groot gedeelte verantwoordelijk voor het ontstaan van maagkanker.

Het gaat om deze studie: Family History of Gastric Cancer and Helicobacter pylori Treatment

In een gerandomiseerde, gecontroleerde studie uit Korea werden 1676 patiënten met Helicobacter pylori-infectie en een eerstegraads familielid met maagkanker gerandomiseerd naar de effecten van een driedubbele bestrijdingsbehandeling of placebo. Surveillance-endoscopieën werden om de 2 jaar uitgevoerd. H. pylori werd uitgeroeid bij 70,1% van de behandelingsgroep en bij 7,1% van de placebogroep.
Tijdens een mediane follow-up periode van 9,2 jaar ontwikkelde maagkanker zich bij 1,2% van de behandelingsgroep versus 2,7% van de placebo-groep (HR, 0,45). Maagkanker ontwikkelde zich bij 2,9% van de patiënten met een aanhoudende H. pylori-infectie en 0,8% bij patiënten met succesvolle uitroeiing van de H. pylori bacterie (HR, 0,27).

Lees ook verderop in dit artikel en in gerelateerde artikelen hoe je met voeding en voedingsstoffen ook heel goed de H. pylori bacterie kunt elimineren, zie ook o.a. dit studierapport: Medicinal plant activity on Helicobacter pylori related diseases).

31 maart 2018: Bron: N Engl J Med 2018; 378:1085-1095

Wanneer mensen waarbij een endoscopische operatie van vroege maagkanker is uitgevoerd of sprake is van een hooggradig adenoom daarna een behandeling krijgen met antibiotica gericht op het elimineren van de H. pylori bacterie dan geeft dat betere resultaten in vergelijking met een placebo.

Citaat uit die studie: Many medicinal plant products possess anti-Helicobacter pylori (H. pylori) activity as well as an anti-H. pylori induced gastric inflammatory effect. Those plant products have showed great potential as pharmaceutical candidates for H. pylori eradication and H. pylori induced related gastric disease prevention.

Onder foto gaat tekst door.

H.Pilory Bacterie beeld H. Pylori en maagkanker

Uit een recente placebo gecontroleerde gerandomiserde studie kwam naar voren dat

1. Er zich minder ontwikkelende maagkanker werd ontdekt bij een endoscopie een jaar later.
2. 3 jaar later zagen de onderzoekers een verbetering ten opzichte van de uitgangswaarden van de ernst van de zogeheten glandulaire atrofie bij de follow-up meting na 3 jaar.

Uit het abstract van de studie:

This study was a prospective, double-blind, placebo-controlled, randomized trial that assigned 470 patients who had undergone endoscopic resection of early gastric cancer or high-grade adenoma to receive either H. pylori eradication therapy with antibiotics or placebo. A total of 396 patients were included in the modified intention-to-treat analysis population (194 in the treatment group and 202 in the placebo group). During a median follow-up of 5.9 years, metachronous gastric cancer developed in 14 patients (7.2%) in the treatment group and in 27 patients (13.4%) in the placebo group (treatment group HR, 0.50; P = .03). Among the 327 patients in the subgroup that underwent histologic analysis, improvement from baseline in the atrophy grade at the gastric corpus lesser curvature was observed in 48.4% of the patients in the treatment group and in 15.0% of those in the placebo group (P < .001). There were no serious adverse events; mild adverse events were more common in the treatment group (42.0% vs 10.2%; P < .001).
Patients with early gastric cancer who received H. pylori treatment had lower rates of metachronous gastric cancer and more improvement from baseline in the grade of gastric corpus atrophy than patients who received placebo.

Het volledige studierapport: Helicobacter pylori Therapy for the Prevention of Metachronous Gastric Cancer is tegen betaling in te zien.

30 mei 2017: Bron de Volkskrant en WJG - World Journal of Gastroenterology

In de Volkskrant wetenschappelijke rubriek VOEDING werd afgelopen week deze vraag behandeld: Kan voeding een maagzweer laten verdwijnen?

N.a.v. daarvan hier een reviewstudie uit 2014 over ditzelfde onderwerp: Exploring alternative treatments for Helicobacter pylori infection

en uit 2016 een reviewstudie: Nutrition and Helicobacter pylori: Host Diet and Nutritional Immunity Influence Bacterial Virulence and Disease Outcome en een nieuwe publicatie over de rol van probiotica in de bestrijding van de Helico bacter Pylori, de veroorzaker van maagzweren en meestal ook de bron van maagkanker: Role of Probiotics in Managing of Helicobacter Pylori Infection: A Review

Bron: WJG 2014: Mechanism used in the alternative strategies described here for the treatment of Helicobacter pylori. Three levels are considered as targets for the different alternative treatments. The first involves the host, where vaccines and immune response modulators could act. The second is the stomach, where many mechanisms could have different types of action to restore homeostasis (i.e., gastroprotection, anti-inflammatory). Finally, Helicobacter pylori is the central target; in this case, alternative treatments are intended to eradicate or prevent the infection, acting upon growth or colonisation factors. In the case of growth inhibitors, many bacterial targets could be used as key enzymes and pathways.

Een paar citaten uit het artikel van de Volkskrant:

Kan voeding een maagzweer laten verdwijnen?

.........Een maagzweer wordt vaak veroorzaakt door de bacterie Helicobacter pylori, die zich nestelt in de beschermende slijmlaag van de maagwand. De bacterie veroorzaakt een chronische ontsteking van het maagslijmvlies. Daar merk je meestal niets van, verduidelijkt Ernst Kuipers, hoogleraar maag- darm- leverziektes in het Erasmus MC. Maar soms tast die ontsteking het slijmvlies en de slijmlaag aan waarna het maagzuur op die plek kan inwerken en een wond veroorzaakt. De zenuwen eronder komen bloot te liggen en als het maagzuur ermee in contact komt, ontstaat heftige pijn. De eerste maagzweerdiëten dateren van een eeuw geleden. Beroemd was het Sippy-dieet, vernoemd naar de Amerikaanse arts Bertram Sippy, die zijn patiënten dagenlang alleen melk gaf..........Het melkdruppel-dieet bleek niet te werken.

Doeltreffender is het vermijden van bepaalde dranken. Vooral koffie en alcohol zijn boosdoeners omdat ze de aanmaak van maagzuur stimuleren............

Een dieet tegen maagzuur is niet meer zo nodig, zegt Kuipers: er zijn geneesmiddelen, maagzuurremmers, die de productie van zuur in de maag veel beter afremmen dan welk voedingsmiddel dan ook.

Veel interessanter vindt hij het om te kijken naar voeding die de oorzaak van de zweer aanpakt: 'Als je de groei van de bacterie kunt afremmen, helpt dat om de ontsteking tegen te gaan.'.............

Het sterkste bewijs ligt er voor broccolispruiten (de kiemen van de broccoliplant), zwarte bessenolie, cranberrysap, kaneel en bepaalde probiotica. Die voedingsmiddelen pakken de Helicobacter-bacterie op uiteenlopende manieren aan: ze remmen de groei of het venijn van de bacterie, beperken de mogelijkheid om zich in de maagwand te nestelen of voorkomen dat de bacterie een beschermde jas krijgt waardoor het lastig wordt om in de zure maag te overleven.........

Kuipers wijst erop dat er geen antibioticum bestaat dat alleen de Helicobacter doodt. 'Bestrijden we één soort, dan raken we ook altijd andere soorten.'

Reden genoeg om een dieet een kans te geven. Maar voordat maagpatiënten hun medicijnen inruilen voor veenbessensap of kiemgroenten: eerst moet veel meer onderzoek worden gedaan..........>>>>>>Lees het hele artikel: Kan voeding een maagzweer laten verdwijnen?

Uit de studie: Nutrition and Helicobacter pylori: Host Diet and Nutritional Immunity Influence Bacterial Virulence and Disease Outcome het volgende citaat:

4. Helicobacter pylori en Voeding

Naast genetische verschillen bij de individuele mens of stammen, komen milieufactoren, zoals het dieet van de individuele mens, op als belangrijke componenten van de ecologie binnen de maagomgeving. Het is waarschijnlijk dat de maagomgeving sterk beïnvloed wordt door het voedingspatroon van de individuele mens. Epidemiologische studies hebben aangetoond dat voedingsgewoonten zoals hoge inname van groene thee, fruit of groenten beschermend zijn tegen maagkankerrisico [zie in referenties 37–39]. Omgekeerd blijkt uit case-controlled en cohort studies dat de hoge inname van rood vlees en / of verwerkt vlees (die veel overgangsmetalen bevatten) en conserven (gepekeld, gedroogd, gerookt of gezouten) die vaak zout bevatten, geassocieerd zijn met een verhoogd risico op 'noncardia' maagkanker [zie referenties 40, 41]. Bovendien heeft de komst van de koelkast en vrieskast radicaal de manier waarop voedsel voor opslag wordt voorbereid veranderd. Case-controlled populatiestudies hebben aangetoond dat toegang tot koeling beschermend is tegen maagkanker [zie referentie 42]. Dit is te wijten aan het feit dat koeling leidt tot langdurige toegang tot vers voedsel zoals fruit en groenten, die anders niet beschikbaar zouden zijn. Er wordt verondersteld dat carotenoïden, foliumzuur, vitamine C en fytochemicaliën van groenten en fruit een beschermende rol hebben tegen carcinogenese ( vorming van kankercellen). Omgekeerd kunnen zout en de beschikbaarheid van sommige overgangsmetalen de H. pylori activiteit veranderen en vorming van kwaadaardige tumorcellen (carcinogenese) versnellen [zie referenties: 43, 44]. De bijdrage van deze individuele micronutriënten aan H. pylori-afhankelijke ziekten wordt hieronder (zie volledige studierapprot) nader onderzocht.

Oorspronkelijke tekst van de tekst hierboven zoals ik die heb vertaald:

4. H. pylori and Nutrition

In addition to host or strain genetic differences, environmental factors, such as host diet, are emerging as important components of the ecology within the gastric environment. It is likely that the gastric environment is highly influenced by host nutrient intake. Epidemiological studies have revealed that dietary habits such as high intake of green tea, fruits, or vegetables are protective against gastric cancer risk [37–39]. Conversely, case-controlled and cohort studies reveal that high intake of red meat and/or processed meat (which are high in transition metals) and preserved foods (pickled, dried, smoked, or salted) which are often high in salt is associated with increased risk of noncardia gastric cancer [40, 41]. Furthermore, the advent of refrigeration has radically changed the manner in which food is prepared for storage. Case-controlled population studies have demonstrated that access to refrigeration is protective against gastric cancer [42]. This is attributed to the fact that refrigeration leads to prolonged access to fresh foods such as fruits and vegetables, which would otherwise be unavailable. It is hypothesized that carotenoids, folate, vitamin C, and phytochemicals from fruits and vegetables have a protective role against carcinogenesis. Conversely, salt and the availability of some transition metals can alter H. pylori virulence and accelerate carcinogenesis [43, 44]. The contribution of these individual micronutrients to H. pylori-dependent diseases will be reviewed in detail below.

Het blijkt dus dat voeding een grote rol kan spelen in het voorkomen van de heliobacter Pyl;ori bacterie, maar niet duidelijjk is precies welke voedingstoffen precies het beste werken. Wat veel onderzocht is zijn de verschiullende melkzuurbacteriën (probiotica).

In deze studie: The Effect of Probiotics on Gut Microbiota during the Helicobacter pylori Eradication: Randomized Controlled Trial. concluderen de onderzoekers:

Probiotische supplementen kunnen de antibiotica-geïnduceerde verandering en onevenwichtigheid van de darmflora - darmmicrobiota samenstelling verminderen. Dit effect kan de groei van antibiotica resistente bacteriën in de darm beperken en de eliminering van de H. pylori bacterie versnellen. (oorspronkelijke tekst: Probiotic supplementation can reduce the antibiotic-induced alteration and imbalance of the gut microbiota composition. This effect may restrict the growth of antibiotic-resistant bacteria in the gut and improve the H. pylori eradication success rate.

Maar leest u de genoemde studies mocht u mer willen weten.

Hieronder enkele abstracten met referentielijsten:

The intersection of host genetics, immune response, bacterial virulence expression, diet, micronutrient availability, and microbiome structure and composition undoubtedly influence the disease outcomes associated with chronic Helicobacter pylori infection.

. 2016; 2016: 3019362.

Published online 2016 Sep 5. doi: 10.1155/2016/3019362

PMCID: PMC5027306

Nutrition and Helicobacter pylori: Host Diet and Nutritional Immunity Influence Bacterial Virulence and Disease Outcome

Kathryn P. Haley¹ and Jennifer A. Gaddy^{1 ,}^{2 ,}^*

Author information ► Article notes ► Copyright and License information ►

Abstract

Helicobacter pylori colonizes the stomachs of greater than 50% of the world's human population making it arguably one of the most successful bacterial pathogens. Chronic H. pylori colonization results in gastritis in nearly all patients; however in a subset of people, persistent infection with H. pylori is associated with an increased risk for more severe disease outcomes including B-cell lymphoma of mucosal-associated lymphoid tissue (MALT lymphoma) and invasive adenocarcinoma. Research aimed at elucidating determinants that mediate disease progression has revealed genetic differences in both humans and H. pylori which increase the risk for developing gastric cancer. Furthermore, host diet and nutrition status have been shown to influence H. pylori-associated disease outcomes. In this review we will discuss how H. pylori is able to create a replicative niche within the hostile host environment by subverting and modifying the host-generated immune response as well as successfully competing for limited nutrients such as transition metals by deploying an arsenal of metal acquisition proteins and virulence factors. Lastly, we will discuss how micronutrient availability or alterations in the gastric microbiome may exacerbate negative disease outcomes associated with H. pylori colonization.

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Articles from Gastroenterology Research and Practice are provided here courtesy of Hindawi Publishing Corporation

Probiotic supplementation can reduce the antibiotic-induced alteration and imbalance of the gut microbiota composition. This effect may restrict the growth of antibiotic-resistant bacteria in the gut and improve the Helicobacter pylori eradication success rate.

The Effect of Probiotics on Gut Microbiota during the Helicobacter pylori Eradication: Randomized Controlled Trial

Bumjo Oh^1,†,
Bong-Soo Kim^2,†,
Ji Won Kim^3,*,
Jong Seung Kim¹,
Seong-Joon Koh³,
Byeong Gwan Kim³,
Kook Lae Lee³ and
Jongsik Chun^4,5

Version of Record online: 23 SEP 2015

DOI: 10.1111/hel.12270

Abstract

Background

Helicobacter pylori causes chronic gastritis, gastroduodenal ulcers, and gastric cancer, and has been treated with two antibiotics (amoxicillin and clarithromycin) and proton-pump inhibitors (PPIs). However, antibiotic treatment alters the indigenous gut microbiota to cause side effects. Therefore, the effects of probiotic supplementation on therapy have been studied. Although several studies have covered the probiotics’ effects, details about the gut microbiota changes after H. pylori eradication have not been evaluated. Therefore, we analyzed the influences of antibiotics and their combination with probiotics on the composition of the gut microbiota using high-throughput sequencing.

Methods

Subjects were divided into two groups. The antibiotics group was treated with general therapy, and the probiotics group with general therapy and probiotic supplementation. Fecal samples were collected from all subjects during treatments, and the influences on gut microbiota were analyzed by 16S rRNA gene-pyrosequencing.

Results

Three phyla, Firmicutes, Bacteroidetes, and Proteobacteria, were predominant in the gut microbiota of all subjects. After treatment, the relative abundances of Firmicutes were reduced, whereas those of Proteobacteria were increased in both groups. However, the changed proportions of the gut microbiota in the antibiotics group were higher than those in the probiotics group. In addition, the increase in the levels of antibiotic-resistant bacteria was higher in the antibiotics group than in the probiotics one.

Conclusion

Probiotic supplementation can reduce the antibiotic-induced alteration and imbalance of the gut microbiota composition. This effect may restrict the growth of antibiotic-resistant bacteria in the gut and improve the H. pylori eradication success rate.

probiotica, Clostridium difficile infectie, antibiotica, infecties, maagzweer, Helicobacter pylori, voeding en voedingsstoffen, groene thee