Original Article

Effect of N-Acetyl Cysteine on Helicobacter pylori

Authors: Ahmet Kemal Gurbuz, MD, A Melih Ozel, MD, Ramazan Ozturk, MD, Sukru Yildirim, MD, Yusuf Yazgan, MD, Levent Demirturk, MD

Abstract

Background: Use of mucolytic agents that result in reduced mucous viscosity of the gastric mucous has been suggested to have an additive effect in curing Helicobacter pylori infection.


Methods: Seventy H pylori–positive patients were given either eradication treatment consisting of 500 mg clarithromycin bid and 30 mg lansoprazole bid for 10 days plus 10 mL (400 mg) N-acetyl cysteine (NAC) liquid tid (AC group) or eradication treatment only (control group). The results were compared 1 month after the completion of the treatment.


Results: Fifty-eight patients were available for statistical analysis. Of the 28 patients in the AC group, 14 (50.0%) eradicated the infection after treatment, whereas only 7 of 30 (23.3%) patients in the control group had negative results. The difference between the AC group and the control group was statistically significant (P = 0.034). In both groups, there was no difference in the number of smokers and in the eradication rates between smokers and nonsmokers. Eradication treatment with or without NAC caused no significant side effects in either group.


Conclusions: Our findings suggest that NAC has an additive effect on the eradication rates ofH pylori obtained with dual therapy with lansoprazole and clarithromycin. NAC does not have any known activity against H pylori, but it may improve the delivery of antibiotics at the site of infection due to its ability to reduce the thickness of the mucus.


Key Points


* The use of agents that result in reduced mucous viscosity, such as N-acetyl cysteine (NAC), might have an additive effect in curing Helicobacter pylori infection.


* Eradication treatment with NAC caused no significant side effects.


* Our findings suggest that NAC has an additive effect on the eradication rates of H pyloriobtained with combination therapy consisting of lansoprazole and clarithromycin.

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References

1. Bechi P, Balzi M, Becciolini A, et al. Helicobacter pylori and cell proliferationof the gastric mucosa: possible implications for gastric carcinogenesis. AmJ Gastroenterol 1996;91:271–276.
 
2. Kuipers EJ, Uyterlinde AM, Pena AS, et al. Long-term sequelae of Helicobacter pylori gastritis.Lancet 1995;345:1525–1528.
 
3. Marshall BJ. Helicobacter pylori: the etiologic agent for peptic ulcer. JAMA 1995;274:1064–1066.
 
4. Valle J, Kekki M, Sipponen P, et al. Long-term course and consequences of Helicobacter pylori gastritis: results of a32-year follow-up study. Scand J Gastroenterol 1996;31:546–550.
 
5. Rauws EA, Tytgat GN. Cure of duodenal ulcer associated with eradication of Helicobacter pylori.Lancet 1990;335:1233–1235.
 
6. Graham DY, Lew GM, Klein PD, et al. Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer: a randomized, controlled study. Ann Intern Med1992;116:705–708.
 
7. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175–1186.
 
8. Millman M, Goodman AH, Goldstein IM, et al. Treatment of a patient with chronic bronchial asthma with many bronchoscopies and lavage using acetylcysteine: a case report. J Asthma 1985;22:13–35.
 
9. Hazell SL, Lee A, Brady L, et al. Campylobacter pyloridis and gastritis: association with intercellular spaces and adaptation to an environment of mucus as important factors in colonization of the gastric epithelium. J Infect Dis 1986;153:658–663.
 
10. Demirturk L, Yazgan Y, Tarcin O, et al. Does N-acetyl cysteine affect the sensitivity and specificity of Helicobacter pylori stool antigen test? Helicobacter 2003;8:120–123.
 
11. Gotoh A, Akamatsu T, Shimizu et al. Additive effect of pronase on the efficacy of eradication therapy against Helicobacter pylori. Helicobacter 2002;7:183–191.
 
12. Zala G, Flury R, Wust J, et al. Omeprazole/amoxicillin: improved eradication of Helicobacter pylori in smokers because of N-acetylcysteine [in German]. Schweiz Med Wochenschr 1994;124:1391–1397.
 
13. Matthews GM, Kritas S, Tivey D, et al. N-acetylcysteine reduces mucosal glutathione and the inflammatory response in Helicobacter pylori infected mice. Helicobacter 2003;8:374.
 
14. Sherwood PV, Wibawa JID, Atherton JC, et al. Impact of acid secretion, gastritis, and mucus thickness on gastric transfer of antibiotics in rats. Gut 2002;51:490–95.
 
15. Böttcher W, Golanska EM, Kauffman GL Jr. N-acetyl-cysteine affords gastric mucosal protection while reducing gel mucus thickness. Surg Forum 1982;33:164–166.
 
16. Henagan JM, Smith GS, Miller TA, et al. N-acetyl-cysteine and prostaglandin: comparable protection against experimental ethanol injury in the stomach independent of mucus thickness. Ann Surg 1986;204:698–704.
 
17. Misawa M, Inamura N. In vitro evaluation of mucolytic activities of some expectorants using porcine gastric mucin. Jpn J Pharmacol 1988;92:263–270.