1
|
Dalmartello M, Turati F, Zhang ZF, Lunet N, Rota M, Bonzi R, Galeone C, Martimianaki G, Palli D, Ferraroni M, Yu GP, Morais S, Malekzadeh R, López-Carrillo L, Zaridze D, Maximovitch D, Aragonés N, Fernández-Tardón G, Martin V, Vioque J, Garcia de la Hera M, Curado MP, Coimbra FJF, Assumpcao P, Pakseresht M, Hu J, Hernández-Ramírez RU, Ward MH, Pourfarzi F, Mu L, Tsugane S, Hidaka A, Lagiou P, Lagiou A, Trichopoulou A, Karakatsani A, Boffetta P, Camargo MC, Negri E, La Vecchia C, Pelucchi C. Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project. Br J Cancer 2022; 126:1755-1764. [PMID: 35210588 PMCID: PMC9174191 DOI: 10.1038/s41416-022-01750-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The role of allium vegetables on gastric cancer (GC) risk remains unclear. METHODS We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the "Stomach cancer Pooling (StoP) Project", including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach. RESULTS Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56-0.90), with substantial heterogeneity across studies (I2 > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55-0.86) for onions and 0.83 (95% CI, 0.75-0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29-0.86) but not European (OR 0.96, 95% CI, 0.81-1.13) and American (OR 0.66, 95% CI, 0.39-1.11) studies. Results were consistent across all other strata. CONCLUSIONS In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.
Collapse
Affiliation(s)
- Michela Dalmartello
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Turati
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. .,Unit of Medical Statistics and Biometry, National Cancer Institute of Milan, Milan, Italy.
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Rossella Bonzi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Georgia Martimianaki
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hellenic Health Foundation, Athens, Greece
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy
| | - Monica Ferraroni
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Peking, China
| | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Zaridze
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Dmitry Maximovitch
- Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | | | - Vicente Martin
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Biomedicina (IBIOMED), Universidad de León, León, Spain
| | - Jesus Vioque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 46020, Alicante, Spain
| | - Manoli Garcia de la Hera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL-UMH, 46020, Alicante, Spain
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil
| | | | - Paulo Assumpcao
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Mohammadreza Pakseresht
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.,Nutritional Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
| | - Jinfu Hu
- Harbin Medical University, Harbin, China
| | | | - Mary H Ward
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Farhad Pourfarzi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Areti Lagiou
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece.,2nd Pulmonary Medicine Department, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Haidari, Greece
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Costanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Eva Negri
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudio Pelucchi
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
2
|
Baker DA. Plants against Helicobacter pylori to combat resistance: An ethnopharmacological review. ACTA ACUST UNITED AC 2020; 26:e00470. [PMID: 32477900 PMCID: PMC7248673 DOI: 10.1016/j.btre.2020.e00470] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Abstract
Worldwide, Helicobacter pylori (H. pylori) is regarded as the major etiological agent of peptic ulcer and gastric carcinoma. Claiming about 50 percent of the world population is infected with H. pylori while therapies for its eradication have failed because of many reasons including the acquired resistance against its antibiotics. Hence, the need to find new anti-H.pylori medications has become a hotspot with the urge of searching for alternative, more potent and safer inhibitors. In the recent drug technology scenario, medicinal plants are suggested as repositories for novel synthetic substances. Hitherto, is considered as ecofriendly, simple, more secure, easy, quick, and less toxic traditional treatment technique. This review is to highlight the anti-H. pylori medicinal plants, secondary metabolites and their mode of action with the aim of documenting such plants before they are effected by cultures and traditions that is expected as necessity.
Collapse
Affiliation(s)
- Doha Abou Baker
- Medicinal and Aromatic Plants Dept., Pharmaceutical and Drug Industries Division, National Research Centre, Cairo, Egypt
| |
Collapse
|
3
|
Li Z, Ying X, Shan F, Ji J. The association of garlic with Helicobacter pylori infection and gastric cancer risk: A systematic review and meta-analysis. Helicobacter 2018; 23:e12532. [PMID: 30155945 DOI: 10.1111/hel.12532] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Garlic may be protective against Helicobacter pylori infection and gastric cancer development. We conducted this study to quantitatively update evidence on garlic intake and gastric cancer with the inclusion of most recent cohort studies and qualitatively summarize epidemiological studies of garlic consumption and Helicobacter pylori infection. MATERIALS AND METHODS PubMed, Embase, MEDLINE, and Cochrane Library were searched on April 2018. We conducted a meta-analysis to determine whether garlic intake reduced gastric cancer risk using random-effect models and a systematic review to summarize evidence on the association between garlic consumption and Helicobacter pylori infection. Risk of bias was assessed using tools of Cochrane risk of bias and Robins-I for randomized and nonrandomized studies, respectively. RESULTS Meta-analysis of 18 studies (142 921 subjects) demonstrated high garlic consumption (as comparing the highest category to the lowest) was associated with a reduced gastric cancer risk (OR = 0.51, 95% CI = 0.44-0.57). This association became nonsignificant if only derived from the prospective studies (OR = 0.95, 95% CI = 0.66-1.24). Thirteen studies (4889 participants) were included in the systematic review for garlic consumption and Helicobacter pylori infection; ten of which found no significant results. The majority of these studies were poor in quality given the small sample size and high risk of bias. CONCLUSIONS Pooled evidence, mainly from case-control studies, suggested a significant inverse association of garlic intake with gastric cancer risk. Given the limitations of included studies, current epidemiological evidence is not sufficient to reach any definite conclusion regarding the association of garlic with Helicobacter pylori infection.
Collapse
Affiliation(s)
- Ziyu Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiangji Ying
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fei Shan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiafu Ji
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| |
Collapse
|
4
|
Kim H, Keum N, Giovannucci EL, Fuchs CS, Bao Y. Garlic intake and gastric cancer risk: Results from two large prospective US cohort studies. Int J Cancer 2018; 143:1047-1053. [PMID: 29569711 DOI: 10.1002/ijc.31396] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 02/19/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
Although many case-control studies suggested that garlic intake may reduce gastric cancer risk, evidence from prospective cohort studies has been lacking. We examined the association between garlic intake and subsequent risk of gastric cancer among 77,086 women in the Nurses' Health Study (1984-2014) and 46,398 men in the Health Professionals Follow-Up Study (1986-2014). Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models. We additionally examined garlic intake in relation to Helicobacter pylori (H. pylori) infection among 613 participants using logistic regression. During up to 30 years of follow-up, 292 participants were diagnosed with gastric cancer. The pooled multivariable RR of gastric cancer among participants who ate garlic, as compared to those who did not, were 1.11 (95% CI = 0.81-1.51) for the intake of garlic less than once per week, 0.98 (95% CI = 0.71-1.36) for one to four times per week and 1.39 (95% CI = 0.89-2.17) for five or more times per week (p for trend = 0.23). Similarly, no statistically significant association was observed cross-sectionally between garlic intake and H. pylori infection (comparing five or more times per week to never, pooled multivariable odds ratio = 1.66, 95% CI = 0.89-3.09; p for trend = 0.11). The findings from this large prospective study do not support the hypothesis that high garlic intake reduces risk of gastric cancer.
Collapse
Affiliation(s)
- Hanseul Kim
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - NaNa Keum
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Food Science and Biotechnology, Dongguk University, Goyang, South Korea
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT
| | - Ying Bao
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| |
Collapse
|
5
|
Zaidi SF, Ahmed K, Saeed SA, Khan U, Sugiyama T. Can Diet Modulate Helicobacter pylori-associated Gastric Pathogenesis? An Evidence-Based Analysis. Nutr Cancer 2017; 69:979-989. [PMID: 28937799 DOI: 10.1080/01635581.2017.1359310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Helicobacter pylori is involved in the pathogenesis of gastritis, peptic ulcer, and gastric cancer. The infection is prevalent in more than half of the world's population. Although the infection may lead to detrimental consequences, still the majority of the infected individuals only develop mild gastritis. Several factors are behind this paradoxical outcome including virulence of the infecting H. pylori strains, genetic background of the host, and factors related to lifestyle such as dietary habits. Among these, lifestyle including dietary factors was not in the limelight, until recently, as one of the important factors that could modulate H. pylori-linked gastric diseases. This review is directed to gather and elucidate the role of dietary components in augmenting or attenuating pathological processes initiated by H. pylori. Available evidence strongly supports the notion that the diet may play a critical role in defining the final outcome of H. pylori infection particularly if certain dietary components are taken on a regular basis for a long time. Despite a recent surge in research related to the role of dietary ingredients, further studies involving large-scale clinical trials are required to gain a better understanding of the precise role played by the dietary ingredients in H. pylori-associated pathogenesis.
Collapse
Affiliation(s)
- Syed Faisal Zaidi
- a Department of Basic Medical Sciences, College of Medicine , King Saud bin Abdulaziz University of Health Sciences , Jeddah , Kingdom of Saudi Arabia
| | - Kanwal Ahmed
- a Department of Basic Medical Sciences, College of Medicine , King Saud bin Abdulaziz University of Health Sciences , Jeddah , Kingdom of Saudi Arabia
| | - Sheikh Abdul Saeed
- a Department of Basic Medical Sciences, College of Medicine , King Saud bin Abdulaziz University of Health Sciences , Jeddah , Kingdom of Saudi Arabia
| | - Usmanghani Khan
- b Faculty of Pharmacy , Jinnah University for Women , Karachi , Pakistan
| | - Toshiro Sugiyama
- c Department of Gastroenterology, Faculty of Medicine , University of Toyama , Toyama , Japan
| |
Collapse
|
6
|
Han YM, Park JM, Jeong M, Yoo JH, Kim WH, Shin SP, Ko WJ, Hahm KB. Dietary, non-microbial intervention to prevent Helicobacter pylori-associated gastric diseases. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207250 DOI: 10.3978/j.issn.2305-5839.2015.03.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Since the discovery of Helicobacter pylori (H. pylori) infection as the major cause of gastroduodenal disorders including acute and chronic gastritis, gastroduodenal ulcer, chronic atrophic gastritis, and gastric cancer almost three decades ago, the possibility of preventing these clinical diseases through eradicating H. pylori has been the focus of active research, but soon debate in the scientific community, though eradication opens the feasibility of cancer prevention and the removal of bacteria significantly prevents development or recurrence of peptic ulcer diseases and some clinical diseases, was proposed due to uncertainty in either achievement of complete eradication or inefficacy in cancer prevention with eradication alone. Still its linkage to gastric cancer is incontestable. Since the multiple combination of bacterial factors, environmental insults, and the host immune response that drives the initiation and progression of mucosal atrophy, metaplasia, and dysplasia toward gastric cancer is intervened, simple eradication deemed the feasibility of cancer prevention. Therefore, our group open strong hypothesis that non-microbial, dietary approach might be the alternate, for which several interventions of nutritional components can highlight rejuvenation of chronic atrophic gastritis as well as amelioration of H. pylori-associated procarcinogenic inflammation. In this review article, the experience and outcome regarding nutritional application to rejuvenate gastric atrophy will be introduced, using Korean red ginseng, garlic extracts, cancer preventive Korea kimchi, n-3 polyunsaturated fatty acids (PUFA), special form of licorice, and probiotics. The detailed influence of dietary intervention and bacterial eradication therapy on disease progression and reversibility of premalignant lesions are discussed.
Collapse
Affiliation(s)
- Young-Min Han
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Jong-Min Park
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Migyeong Jeong
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Jun-Hwan Yoo
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Won-Hee Kim
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Seok-Pyo Shin
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Weon-Jin Ko
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| | - Ki-Baik Hahm
- 1 CHA University Cancer Prevention Research Center, CHA Bio Complex, Seongnam 463-400, Korea ; 2 Department of Gastroenterology, CHA University Bundang Medical Center, Seongnam 463-712, Korea
| |
Collapse
|
7
|
Safavi M, Shams-Ardakani M, Foroumadi A. Medicinal plants in the treatment of Helicobacter pylori infections. PHARMACEUTICAL BIOLOGY 2015; 53:939-960. [PMID: 25430849 DOI: 10.3109/13880209.2014.952837] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT Helicobacter pylori is a small, spiral, Gram-negative bacillus that plays a role in the pathogenesis of a number of diseases ranging from asymptomatic gastritis to gastric cancer. Schedule compliance, antibiotic drug resistance, and side-effects of triple or quadruple therapy have led to research for novel candidates from plants. OBJECTIVE The purpose of this paper is to review the most potent medicinal plants of recently published literature with anti-H. pylori activity. For centuries, herbals have been used by traditional healers around the world to treat various gastrointestinal tract disorders such as dyspepsia, gastritis, and peptic ulcer disease. The mechanism of action by which these botanicals exert their therapeutic properties has not been completely and clearly elucidated. Anti-H. pylori properties may be one of the possible mechanisms by which gastroprotective herbs treat gastrointestinal tract disorders. MATERIALS AND METHODS Electronic databases such as PubMed, Google scholar, EBSCO, and local databases were explored for medicinal plants with anti-H. pylori properties between 1984 and 2013 using key words "medicinal plants" and "Helicobacter pylori" or "anti-Helicobacter pylori". RESULTS A total of 43 medicinal plant species belonging to 27 families including Amaryllidaceae, Anacardiaceae, Apiaceae, Apocynaceae, Asclepiadoideae, Asteraceae, Bignoniaceae, Clusiaceae, Chancapiedra, Combretaceae, Cyperaceae, Euphorbiaceae, Fabaceae, Geraniaceae, Lamiaceae, Lauraceae, Lythraceae, Menispermaceae, Myristicaceae, Myrtaceae, Oleaceae, Papaveraceae, Plumbaginaceae, Poaceae, Ranunculaceae, Rosaceae, and Theaceae were studied as herbs with potent anti-H. pylori effects. CONCLUSION Traditional folk medicinal use of some of these plants to treat gastric infections is substantiated by the antibacterial activity of their extracts against H. pylori.
Collapse
Affiliation(s)
- Maliheh Safavi
- Department of Biotechnology, Iranian Research Organization for Science and Technology (IROST) , Tehran , Iran
| | | | | |
Collapse
|
8
|
Park JM, Han YM, Kangwan N, Lee SY, Jung MK, Kim EH, Hahm KB. S-allyl cysteine alleviates nonsteroidal anti-inflammatory drug-induced gastric mucosal damages by increasing cyclooxygenase-2 inhibition, heme oxygenase-1 induction, and histone deacetylation inhibition. J Gastroenterol Hepatol 2014; 29 Suppl 4:80-92. [PMID: 25521739 DOI: 10.1111/jgh.12730] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Nonsteroidal anti-inflammatory drugs (NSAIDs), the most highly prescribed drugs in the world for the treatment of pain, inflammation, and fever, are associated with gastric mucosal damages including ulcer directly or indirectly. This study was aimed to document the preventive effects of an organosulfur constituent of garlic, S-allyl cysteine (SAC), against NSAIDs-induced gastric damages, as well the elucidation of its pharmacological actions, such as anti-inflammatory, anti-oxidative, and cytoprotective actions. METHODS Different doses of SAC were administrated intragastrically before the indomethacin administration. After killing, in addition to gross and pathological evaluations of ulcer, the expressions of inflammatory mediators, including cyclooxygenase-2, prostaglandin E2 , IL-1β, tumor necrosis factor-α, IL-6, and anti-oxidant capacity, were analyzed by Western blot analysis or ELISA, respectively. Transferase deoxytidyl uridine end labeling assay, periodic acid and Schiff staining, F4/80 staining, and CD31 staining were compared among doses of SAC. Detailed documentation of in vitro biological actions of SAC, including NF-κB, histone deacetylator inhibition, phase 2 enzyme, and MAPKs, was performed. RESULTS SAC was very effective in preventing indomethacin-induced gastric damages in a low dose through significant decreases in macrophage infiltration as well as restorative action. Indomethacin-induced expressions of inflammatory mediators were all significantly attenuated with SAC in accordance with histone deacetylator inhibition. In addition, SAC significantly increased the total anti-oxidant concentration and mucus secretion, and allows for a significant induction of HO-1. However, these preventive effects of SAC were dependent on dosage of SAC; higher dose above 10 μM paradoxically aggravated NSAID-induced inflammation. CONCLUSION Synthetic SAC can be promising therapeutics agent to provide potent anti-inflammatory, anti-oxidative, and mucosa protective effects against NSAID-induced damages.
Collapse
Affiliation(s)
- Jong-Min Park
- CHA Cancer Prevention Research Center, CHA Cancer Institute, CHA University, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
9
|
Li WQ, Ma JL, Zhang L, Brown LM, Li JY, Shen L, Pan KF, Liu WD, Hu Y, Han ZX, Crystal-Mansour S, Pee D, Blot WJ, Fraumeni JF, You WC, Gail MH. Effects of Helicobacter pylori treatment on gastric cancer incidence and mortality in subgroups. J Natl Cancer Inst 2014; 106:dju116. [PMID: 24925350 DOI: 10.1093/jnci/dju116] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Among 2258 Helicobacter pylori-seropositive subjects randomly assigned to receive one-time H. pylori treatment with amoxicillin-omeprazole or its placebo, we evaluated the 15-year effect of treatment on gastric cancer incidence and mortality in subgroups defined by age, baseline gastric histopathology, and post-treatment infection status. We used conditional logistic and Cox regressions for covariable adjustments in incidence and mortality analyses, respectively. Treatment was associated with a statistically significant decrease in gastric cancer incidence (odds ratio = 0.36; 95% confidence interval [CI] = 0.17 to 0.79) and mortality (hazard ratio = 0.26; 95% CI = 0.09 to 0.79) at ages 55 years and older and a statistically significant decrease in incidence among those with intestinal metaplasia or dysplasia at baseline (odds ratio = 0.56; 95% CI = 0.34 to 0.91). Treatment benefits for incidence and mortality among those with and without post-treatment infection were similar. Thus H. pylori treatment can benefit older members and those with advanced baseline histopathology, and benefits are present even with post-treatment infection, suggesting treatment can benefit an entire population, not just the young or those with mild histopathology.
Collapse
Affiliation(s)
- Wen-Qing Li
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Jun-Ling Ma
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Lian Zhang
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Linda M Brown
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Ji-You Li
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Lin Shen
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Kai-Feng Pan
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Wei-Dong Liu
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Yuanreng Hu
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Zhong-Xiang Han
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Susan Crystal-Mansour
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - David Pee
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - William J Blot
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Joseph F Fraumeni
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB)
| | - Wei-Cheng You
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB).
| | - Mitchell H Gail
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (W-QL, JFF, MHG); Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China (W-QL, J-LM, LZ, J-YL, LS, K-FP, W-CY); RTI International, Rockville, MD (LMB); Linqu County Public Health Bureau, Shandong, China (W-DL, Z-XH); Westat, Rockville, MD (SC-M); Information Management Services, Rockville, MD (DP); International Epidemiology Institute, Rockville, MD (WJB); Department of Medicine (Epidemiology), Vanderbilt University, Nashville, TN (WJB).
| |
Collapse
|
10
|
Anti-inflammatory mechanism of polyunsaturated fatty acids in Helicobacter pylori-infected gastric epithelial cells. Mediators Inflamm 2014; 2014:128919. [PMID: 24987192 PMCID: PMC4060060 DOI: 10.1155/2014/128919] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/16/2014] [Indexed: 01/29/2023] Open
Abstract
Helicobacter pylori is an important risk factor for gastric inflammation, which is mediated by multiple signaling pathways. The aim of this study was to investigate the effects of polyunsaturated fatty acids (PUFAs), such as linoleic acid (LA), alpha-linolenic acid (ALA), and docosahexaenoic acid (DHA), on the expression of the proinflammatory chemokine interleukin-8 (IL-8) in H. pylori-infected gastric epithelial AGS cells. To investigate whether PUFAs modulate H. pylori-induced inflammatory signaling, we determined the activation of epidermal growth factor receptor (EGFR), protein kinase C-δ (PKC δ), mitogen-activated protein kinases (MAPKs), nuclear factor-kappa B (NF- κB), and activator protein-1 (AP-1) as well as IL-8 expression in H. pylori-infected gastric epithelial cells that had been treated with or without PUFAs. We found that PUFAs inhibited IL-8 mRNA and protein expression in H. pylori-infected cells. ω-3 fatty acids (ALA, and DHA) suppressed the activation of EGFR, PKC δ, MAPK, NF- κB, and AP-1 in these infected cells. LA did not prevent EGFR transactivation and exhibited a less potent inhibitory effect on IL-8 expression than did ALA and DHA. In conclusion, PUFAs may be beneficial for prevention of H. pylori-associated gastric inflammation by inhibiting proinflammatory IL-8 expression.
Collapse
|
11
|
Nontraditional therapies to treat Helicobacter pylori infection. J Microbiol 2014; 52:259-72. [PMID: 24682990 DOI: 10.1007/s12275-014-3603-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/16/2013] [Indexed: 12/15/2022]
Abstract
The Gram-negative pathogen Helicobacter pylori is increasingly more resistant to the three major antibiotics (metronidazole, clarithromycin and amoxicillin) that are most commonly used to treat infection. As a result, there is an increased rate of treatment failure; this translates into an overall higher cost of treatment due to the need for increased length of treatment and/or the requirement for combination or sequential therapy. Given the rise in antibiotic resistance, the complicated treatment regime, and issues related to patient compliance that stem from the duration and complexity of treatment, there is clearly a pressing need for the development of novel therapeutic strategies to combat H. pylori infection. As such, researchers are actively investigating the utility of antimicrobial peptides, small molecule inhibitors and naturopathic therapies. Herein we review and discuss each of these novel approaches as a means to target this important gastric pathogen.
Collapse
|
12
|
Morgan DR, Torres J, Sexton R, Herrero R, Salazar-Martínez E, Greenberg ER, Bravo LE, Dominguez RL, Ferreccio C, Lazcano-Ponce EC, Meza-Montenegro MM, Peña EM, Peña R, Correa P, Martínez ME, Chey WD, Valdivieso M, Anderson GL, Goodman GE, Crowley JJ, Baker LH. Risk of recurrent Helicobacter pylori infection 1 year after initial eradication therapy in 7 Latin American communities. JAMA 2013; 309:578-86. [PMID: 23403682 PMCID: PMC3697935 DOI: 10.1001/jama.2013.311] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The long-term effectiveness of Helicobacter pylori eradication programs for preventing gastric cancer will depend on recurrence risk and individual and community factors. OBJECTIVE To estimate risk of H. pylori recurrence and assess factors associated with successful eradication 1 year after treatment. DESIGN, SETTING, AND PARTICIPANTS Cohort analysis of 1463 randomized trial participants aged 21 to 65 years from 7 Latin American communities, who were treated for H. pylori and observed between September 2009 and July 2011. INTERVENTIONS Randomization to 1 of 3 treatment groups: 14-day lansoprazole, amoxicillin, and clarithromycin (triple therapy); 5-day lansoprazole and amoxicillin followed by 5-day lansoprazole, clarithromycin, and metronidazole (sequential); or 5-day lansoprazole, amoxicillin, clarithromycin, and metronidazole (concomitant). Participants with a positive (13)C-urea breath test (UBT) 6 to 8 weeks posttreatment were offered voluntary re-treatment with 14-day bismuth-based quadruple therapy. MEASUREMENTS Recurrent infection after a negative posttreatment UBT and factors associated with successful eradication at 1-year follow-up. RESULTS Among participants with UBT-negative results who had a 1-year follow-up UBT (n=1091), 125 tested UBT positive, a recurrence risk of 11.5% (95% CI, 9.6%-13.5%). Recurrence was significantly associated with study site (P = .03), nonadherence to initial therapy (adjusted odds ratio [AOR], 2.94; 95% CI, 1.31-6.13; P = .01), and children in the household (AOR, 1.17; 95% CI, 1.01-1.35 per child; P = .03). Of the 281 with positive posttreatment UBT results, 138 completed re-treatment, of whom 93 tested UBT negative at 1 year. Among the 1340 who had a 1-year UBT, 80.4% (95% CI, 76.4%-83.9%), 79.8% (95% CI, 75.8%-83.5%), and 77.8% (95% CI, 73.6%-81.6%) had UBT-negative results in the triple, sequential, and concomitant groups, respectively (P = .61), with 79.3% overall effectiveness (95% CI, 77.1%-81.5%). In a single-treatment course analysis that ignored the effects of re-treatment, the percentage of UBT-negative results at 1 year was 72.4% (95% CI, 69.9%-74.8%) and was significantly associated with study site (P < .001), adherence to initial therapy (AOR, 0.26; 95% CI, 0.15-0.42; P < .001), male sex (AOR, 1.63; 95% CI, 1.25-2.13; P < .001), and age (AOR, 1.14; 95% CI, 1.02-1.27 per decade; P = .02). One-year effectiveness among all 1463 enrolled participants, considering all missing UBT results as positive, was 72.7% (95% CI, 70.3%-74.9%). CONCLUSIONS AND RELEVANCE One year after treatment for H. pylori infection, recurrence occurred in 11.5% of participants who had negative posttreatment UBT results. Recurrence determinants (ie, nonadherence and demographics) may be as important as specific antibiotic regimen in determining the long-term success of H. pylori eradication interventions. Study findings are relevant to the feasibility of programs for the primary prevention of gastric cancer in high-incidence regions of Latin America. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01061437.
Collapse
Affiliation(s)
- Douglas R Morgan
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Medicine, Vanderbilt Medical Center, Nashville, TN 37232, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2012; 2012:CD007176. [PMID: 22419320 PMCID: PMC8407395 DOI: 10.1002/14651858.cd007176.pub2] [Citation(s) in RCA: 284] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Our systematic review has demonstrated that antioxidant supplements may increase mortality. We have now updated this review. OBJECTIVES To assess the beneficial and harmful effects of antioxidant supplements for prevention of mortality in adults. SEARCH METHODS We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science to February 2011. We scanned bibliographies of relevant publications and asked pharmaceutical companies for additional trials. SELECTION CRITERIA We included all primary and secondary prevention randomised clinical trials on antioxidant supplements (beta-carotene, vitamin A, vitamin C, vitamin E, and selenium) versus placebo or no intervention. DATA COLLECTION AND ANALYSIS Three authors extracted data. Random-effects and fixed-effect model meta-analyses were conducted. Risk of bias was considered in order to minimise the risk of systematic errors. Trial sequential analyses were conducted to minimise the risk of random errors. Random-effects model meta-regression analyses were performed to assess sources of intertrial heterogeneity. MAIN RESULTS Seventy-eight randomised trials with 296,707 participants were included. Fifty-six trials including 244,056 participants had low risk of bias. Twenty-six trials included 215,900 healthy participants. Fifty-two trials included 80,807 participants with various diseases in a stable phase. The mean age was 63 years (range 18 to 103 years). The mean proportion of women was 46%. Of the 78 trials, 46 used the parallel-group design, 30 the factorial design, and 2 the cross-over design. All antioxidants were administered orally, either alone or in combination with vitamins, minerals, or other interventions. The duration of supplementation varied from 28 days to 12 years (mean duration 3 years; median duration 2 years). Overall, the antioxidant supplements had no significant effect on mortality in a random-effects model meta-analysis (21,484 dead/183,749 (11.7%) versus 11,479 dead/112,958 (10.2%); 78 trials, relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05) but significantly increased mortality in a fixed-effect model (RR 1.03, 95% CI 1.01 to 1.05). Heterogeneity was low with an I(2)- of 12%. In meta-regression analysis, the risk of bias and type of antioxidant supplement were the only significant predictors of intertrial heterogeneity. Meta-regression analysis did not find a significant difference in the estimated intervention effect in the primary prevention and the secondary prevention trials. In the 56 trials with a low risk of bias, the antioxidant supplements significantly increased mortality (18,833 dead/146,320 (12.9%) versus 10,320 dead/97,736 (10.6%); RR 1.04, 95% CI 1.01 to 1.07). This effect was confirmed by trial sequential analysis. Excluding factorial trials with potential confounding showed that 38 trials with low risk of bias demonstrated a significant increase in mortality (2822 dead/26,903 (10.5%) versus 2473 dead/26,052 (9.5%); RR 1.10, 95% CI 1.05 to 1.15). In trials with low risk of bias, beta-carotene (13,202 dead/96,003 (13.8%) versus 8556 dead/77,003 (11.1%); 26 trials, RR 1.05, 95% CI 1.01 to 1.09) and vitamin E (11,689 dead/97,523 (12.0%) versus 7561 dead/73,721 (10.3%); 46 trials, RR 1.03, 95% CI 1.00 to 1.05) significantly increased mortality, whereas vitamin A (3444 dead/24,596 (14.0%) versus 2249 dead/16,548 (13.6%); 12 trials, RR 1.07, 95% CI 0.97 to 1.18), vitamin C (3637 dead/36,659 (9.9%) versus 2717 dead/29,283 (9.3%); 29 trials, RR 1.02, 95% CI 0.98 to 1.07), and selenium (2670 dead/39,779 (6.7%) versus 1468 dead/22,961 (6.4%); 17 trials, RR 0.97, 95% CI 0.91 to 1.03) did not significantly affect mortality. In univariate meta-regression analysis, the dose of vitamin A was significantly associated with increased mortality (RR 1.0006, 95% CI 1.0002 to 1.001, P = 0.002). AUTHORS' CONCLUSIONS We found no evidence to support antioxidant supplements for primary or secondary prevention. Beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A. Antioxidant supplements need to be considered as medicinal products and should undergo sufficient evaluation before marketing.
Collapse
Affiliation(s)
- Goran Bjelakovic
- Department of InternalMedicine,Medical Faculty, University ofNis,Nis, Serbia.
| | | | | | | | | |
Collapse
|
14
|
Ma JL, Zhang L, Brown LM, Li JY, Shen L, Pan KF, Liu WD, Hu Y, Han ZX, Crystal-Mansour S, Pee D, Blot WJ, Fraumeni JF, You WC, Gail MH. Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatments on gastric cancer incidence and mortality. J Natl Cancer Inst 2012; 104:488-92. [PMID: 22271764 DOI: 10.1093/jnci/djs003] [Citation(s) in RCA: 330] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the Shandong Intervention Trial, 2 weeks of antibiotic treatment for Helicobacter pylori reduced the prevalence of precancerous gastric lesions, whereas 7.3 years of oral supplementation with garlic extract and oil (garlic treatment) or vitamin C, vitamin E, and selenium (vitamin treatment) did not. Here we report 14.7-year follow-up for gastric cancer incidence and cause-specific mortality among 3365 randomly assigned subjects in this masked factorial placebo-controlled trial. Conditional logistic regression was used to estimate the odds of gastric cancer incidence, and the Cox proportional hazards model was used to estimate the relative hazard of cause-specific mortality. All statistical tests were two-sided. Gastric cancer was diagnosed in 3.0% of subjects who received H pylori treatment and in 4.6% of those who received placebo (odds ratio = 0.61, 95% confidence interval = 0.38 to 0.96, P = .032). Gastric cancer deaths occurred among 1.5% of subjects assigned H pylori treatment and among 2.1% of those assigned placebo (hazard ratio [HR] of death = 0.67, 95% CI = 0.36 to 1.28). Garlic and vitamin treatments were associated with non-statistically significant reductions in gastric cancer incidence and mortality. Vitamin treatment was associated with statistically significantly fewer deaths from gastric or esophageal cancer, a secondary endpoint (HR = 0.51, 95% CI = 0.30 to 0.87; P = .014).
Collapse
Affiliation(s)
- Jun-Ling Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Risk factors of precancerous gastric lesions in a population at high risk of gastric cancer. Chin J Cancer Res 2010. [DOI: 10.1007/s11670-010-0267-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
16
|
Martini S, D'Addario C, Braconi D, Bernardini G, Salvini L, Bonechi C, Figura N, Santucci A, Rossi C. Antibacterial activity of grape extracts on cagA-positive and -negative Helicobacter pylori clinical isolates. J Chemother 2010; 21:507-13. [PMID: 19933041 DOI: 10.1179/joc.2009.21.5.507] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is considerable interest in alternative/adjuvant approaches for the eradication of Helicobacter pylori using biologically active compounds, especially antioxidants from plants. In the present work, we tested the antioxidant and antimicrobial activities of hydro-alcoholic extracts from Colorino, Sangiovese and Cabernet Sauvignon grape cultivars against H. pylori G21 (cagA-negative, cagA-) and 10K, (cagApositive, cagA+) clinical isolates. We determined the minimum bactericidal concentration (MBC) by incubating strain suspensions in Brucella broth with fetal bovine serum and samples at different concentrations in a final volume of 100 microl in a microaerobic atmosphere. After incubation, subcultures were carried out on Brucella agar plates which were incubated for 3-5 days in a microaerobic environment. The lowest concentration in broth, where the subculture on agar showed complete absence of growth, was considered the MBC.The Colorino extract showed the highest antibacterial activity against G21 strain (MBC=1.35 mg/ml), while Sangiovese and Carbernet MBCs were 4.0 mg/ml ca. H. pylori 10K was only susceptible to Colorino after 48 hours (MBC = 3.57 mg/ml). Resveratrol exhibited the highest antibacterial activity. interestingly, the most pathogenic strain (10K) was less susceptible to both the grape extracts and the isolated compounds. These results suggest that the administration of grape extracts and wine constituents, in addition to antibiotics, might be useful in the treatment of H. pylori infection. Should the reduced susceptibility of 10K strain be extended to all the cagA+ H. pylori isolates, which are endowed with cancer promoter activity, this observation may help explain why the organisms expressing CagA are more closely associated with atrophic gastritis and gastric carcinoma development.
Collapse
Affiliation(s)
- S Martini
- Dipartimento de Farmaco Chimico Tecnologico, Università degli Studi de Siena, Siena, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Wang Y, Zhang L, Moslehi R, Ma J, Pan K, Zhou T, Liu W, Brown LM, Hu Y, Pee D, Gail MH, You W. Long-term garlic or micronutrient supplementation, but not anti-Helicobacter pylori therapy, increases serum folate or glutathione without affecting serum vitamin B-12 or homocysteine in a rural Chinese population. J Nutr 2009; 139:106-12. [PMID: 19056661 PMCID: PMC2646216 DOI: 10.3945/jn.108.091389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The effects of a 7.3-y supplementation with garlic and micronutrients and of anti-Helicobacter pylori treatment with amoxicillin (1 g twice daily) and omeprazole (20 mg twice daily) on serum folate, vitamin B-12, homocysteine, and glutathione concentrations were assessed in a rural Chinese population. A randomized, double-blind, placebo-controlled, factorial trial was conducted to compare the ability of 3 treatments to retard the development of precancerous gastric lesions in 3411 subjects. The treatments were: 1) anti-H. pylori treatment with amoxicillin and omeprazole; 2) 7.3-y supplementation with aged garlic and steam-distilled garlic oil; and 3) 7.3-y supplementation with vitamin C, vitamin E, and selenium. All 3 treatments were given in a 2(3) factorial design to subjects seropositive for H. pylori infection; only the garlic supplement and vitamin and selenium supplement were given in a 2(2) factorial design to the other subjects. Thirty-four subjects were randomly selected from each of the 12 treatment strata. Sera were analyzed after 7.3 y to measure effects on folate, vitamin B-12, homocysteine, and glutathione concentrations. Regression analyses adjusted for age, gender, and smoking indicated an increase of 10.2% (95%CI: 2.9-18.1%) in serum folate after garlic supplementation and an increase of 13.4% (95%CI: 5.3-22.2%) in serum glutathione after vitamin and selenium supplementation. The vitamin and selenium supplement did not affect other analytes and the amoxicillin and omeprazole therapy did not affect any of the variables tested. In this rural Chinese population, 7.3 y of garlic supplementation increased the serum folate concentration and the vitamin and selenium supplement increased that of glutathione, but neither affected serum concentrations of vitamin B-12 or homocysteine.
Collapse
Affiliation(s)
- Yujue Wang
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Lian Zhang
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Roxana Moslehi
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Junling Ma
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Kaifeng Pan
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Tong Zhou
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Weidong Liu
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Linda Morris Brown
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Yuangreng Hu
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - David Pee
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Mitchell H. Gail
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| | - Weicheng You
- Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education), Department of Epidemiology, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hai-dian District, Beijing 100036, P.R. China; Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892; Linqu Public Health Bureau, Linqu, Shandong 262600, China; Westat Co., Rockville, MD 20850; and Information Management Services, Rockville, MD 20852
| |
Collapse
|
18
|
Abstract
Helicobacter pylori (H. pylori) infection causes peptic ulcer disease, mucosa-associated lymphoid tissue (MALT) lymphomas and gastric adenocarcinomas, for which the pathogenesis of chronic gastric inflammation prevails and provides the pathogenic basis. Since the role of H. pylori infection is promoting carcinogenesis rather than acting as a direct carcinogen, as several publications show, eradication alone cannot be the right answer for preventing H. pylori-associated gastric cancer. Therefore, a non-antimicrobial approach has been suggested to attain microbe-associated cancer prevention through controlling H. pylori-related chronic inflammatory processes and mediators responsible for carcinogenesis. Phytoceutical is a term for plant products that are active on biological systems. Phytoceuticals such as Korean red ginseng, green tea, red wine, flavonoids, broccoli sprouts, garlic, probiotics and flavonoids are known to inhibit H. pylori colonization, decrease gastric inflammation by inhibiting cytokine and chemokine release, and repress precancerous changes by inhibiting nuclear factor-kappa B DNA binding, inducing profuse levels of apoptosis and inhibiting mutagenesis. Even though further unsolved issues are awaited before phytoceuticals are accepted as a standard treatment for H. pylori infection, phytoceuticals can be a mighty weapon for either suppressing or modulating the disease-associated footprints of H. pylori infection.
Collapse
Affiliation(s)
- Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | | | | |
Collapse
|
19
|
Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev 2008:CD004183. [PMID: 18677777 DOI: 10.1002/14651858.cd004183.pub3] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oxidative stress may cause gastrointestinal cancers. The evidence on whether antioxidant supplements are effective in preventing gastrointestinal cancers is contradictory. OBJECTIVES To assess the beneficial and harmful effects of antioxidant supplements in preventing gastrointestinal cancers. SEARCH STRATEGY We identified trials through the trials registers of the four Cochrane Review Groups on gastrointestinal diseases, The Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 2, 2007), MEDLINE, EMBASE, LILACS, SCI-EXPANDED, and The Chinese Biomedical Database from inception to October 2007. We scanned reference lists and contacted pharmaceutical companies. SELECTION CRITERIA Randomised trials comparing antioxidant supplements to placebo/no intervention examining occurrence of gastrointestinal cancers. DATA COLLECTION AND ANALYSIS Two authors (GB and DN) independently selected trials for inclusion and extracted data. Outcome measures were gastrointestinal cancers, overall mortality, and adverse effects. Outcomes were reported as relative risks (RR) with 95% confidence interval (CI) based on random-effects and fixed-effect model meta-analysis. Meta-regression assessed the effect of covariates across the trials. MAIN RESULTS We identified 20 randomised trials (211,818 participants), assessing beta-carotene (12 trials), vitamin A (4 trials), vitamin C (8 trials), vitamin E (10 trials), and selenium (9 trials). Trials quality was generally high. Heterogeneity was low to moderate. Antioxidant supplements were without significant effects on gastrointestinal cancers (RR 0.94, 95% CI 0.83 to 1.06). However, there was significant heterogeneity (I(2) = 54.0%, P = 0.003). The heterogeneity may have been explained by bias risk (low-bias risk trials RR 1.04, 95% CI 0.96 to 1.13 compared to high-bias risk trials RR 0.59, 95% CI 0.43 to 0.80; test of interaction P < 0.0005), and type of antioxidant supplement (beta-carotene potentially increasing and selenium potentially decreasing cancer risk). The antioxidant supplements had no significant effects on mortality in a random-effects model meta-analysis (RR 1.02, 95% CI 0.97 to 1.07, I(2) = 53.5%), but significantly increased mortality in a fixed-effect model meta-analysis (RR 1.04, 95% CI 1.02 to 1.07). Beta-carotene in combination with vitamin A (RR 1.16, 95% CI 1.09 to 1.23) and vitamin E (RR 1.06, 95% CI 1.02 to 1.11) significantly increased mortality. Increased yellowing of the skin and belching were non-serious adverse effects of beta-carotene. In five trials (four with high risk of bias), selenium seemed to show significant beneficial effect on gastrointestinal cancer occurrence (RR 0.59, 95% CI 0.46 to 0.75, I(2) = 0%). AUTHORS' CONCLUSIONS We could not find convincing evidence that antioxidant supplements prevent gastrointestinal cancers. On the contrary, antioxidant supplements seem to increase overall mortality. The potential cancer preventive effect of selenium should be tested in adequately conducted randomised trials.
Collapse
Affiliation(s)
- Goran Bjelakovic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research,, Department 3344, Rigshospitalet, Copenhagen University Hospital,, Blegdamsvej 9, Copenhagen, Denmark, DK-2100.
| | | | | | | |
Collapse
|
20
|
Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev 2004:CD004183. [PMID: 15495084 DOI: 10.1002/14651858.cd004183.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxidative stress may cause gastrointestinal cancers. The evidence on whether antioxidant supplements are effective in preventing gastrointestinal cancers is contradictory. OBJECTIVES To assess the beneficial and harmful effects of antioxidant supplements in preventing gastrointestinal cancers. SEARCH STRATEGY We identified trials through the trials registers of the four Cochrane Review Groups on gastrointestinal diseases, The Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 1, 2003), MEDLINE, EMBASE, LILACS, and SCI-EXPANDED from inception to February 2003, and The Chinese Biomedical Database (March 2003). We scanned reference lists and contacted pharmaceutical companies. SELECTION CRITERIA Randomised trials comparing antioxidant supplements to placebo/no intervention examining the incidence of gastrointestinal cancers. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials for inclusion and extracted data. The outcome measures were incidence of gastrointestinal cancers, overall mortality, and adverse events. Outcomes were reported as relative risks (RR) with 95% confidence interval (CI) based on fixed and random effects meta-analyses. MAIN RESULTS We identified 14 randomised trials (170,525 participants), assessing beta-carotene (9 trials), vitamin A (4 trials), vitamin C (4 trials), vitamin E (5 trials), and selenium (6 trials). Trial quality was generally high. Heterogeneity was low to moderate. Neither the fixed effect (RR 0.96, 95% CI 0.88 to 1.04) nor random effects meta-analyses (RR 0.90, 95% CI 0.77 to 1.05) showed significant effects of supplementation with antioxidants on the incidences of gastrointestinal cancers. Among the seven high-quality trials reporting on mortality (131,727 participants), the fixed effect (RR 1.06, 95% CI 1.02 to 1.10) unlike the random effects meta-analysis (RR 1.06, 95% CI 0.98 to 1.15) showed that antioxidant supplements significantly increased mortality. Two low-quality trials (32,302 participants) found no significant effect of antioxidant supplementation on mortality. The difference between the mortality estimates in high- and low-quality trials was significant by test of interaction (z = 2.10, P = 0.04). Beta-carotene and vitamin A (RR 1.29, 95% CI 1.14 to 1.45) and beta-carotene and vitamin E (RR 1.10, 95% CI 1.01 to 1.20) significantly increased mortality, while beta-carotene alone only tended to do so (RR 1.05, 95% CI 0.99 to 1.11). Increased yellowing of the skin and belching were non-serious adverse effects of beta-carotene. In four trials (three with unclear/inadequate methodology), selenium showed significant beneficial effect on gastrointestinal cancer incidences. REVIEWERS' CONCLUSIONS We could not find evidence that antioxidant supplements prevent gastrointestinal cancers. On the contrary, they seem to increase overall mortality. The potential cancer preventive effect of selenium should be studied in adequately conducted randomised trials.
Collapse
Affiliation(s)
- G Bjelakovic
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Dept. 7102, H:S Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK 2100 Copenhagen, Denmark.
| | | | | | | |
Collapse
|