Open Source Apothecary At Home / Digestion

Stomach ulcers and Helicobacter pylori

A bacterium causes most ulcers. Antibiotics cure it. Some plant compounds suppress it and none replace the treatment.

remedy

The discovery that Helicobacter pylori causes most peptic ulcers turned an incurable chronic disease into a two-week course of antibiotics, and it is worth being plain about that: the definitive treatment is eradication, and it is highly effective.

Some plant compounds have measurable activity against it. Broccoli sprout extract, which delivers sulforaphane, has been tested in H. pylori-colonised people. Cranberry has been tested as an adjunct. Mastic gum, a resin from Pistacia lentiscus, has trials. Honey has in-vitro activity. The pattern in all of these is the same: real antimicrobial activity in the laboratory, and in people either a partial reduction in colonisation or a modest improvement in symptoms, without reliable eradication.

What that means in practice. For someone with a confirmed ulcer and confirmed H. pylori, the answer is the eradication regimen, full course. Suppressing the organism with a plant compound is how resistance is selected, and a partially treated infection that then recurs is worse than either treating it or leaving it. For someone with dyspepsia and no confirmed infection, a food-level approach is reasonable and harmless.

Broccoli sprouts specifically. The interesting chemistry is that glucoraphanin, the storage form, is converted to sulforaphane by myrosinase, an enzyme released when the plant tissue is damaged. Boiling destroys myrosinase, so boiled broccoli gives much less sulforaphane than the raw or lightly steamed sprout. Adding a pinch of raw radish or mustard powder to cooked broccoli restores some of it, because those have their own myrosinase. That is a real and actionable kitchen fact.

Do not use this section to self-treat an ulcer. Ulcers bleed. A bleeding ulcer is a medical emergency with a mortality rate, and a person treating one with broccoli sprouts is losing days.

What the studies found

Preparation

Broccoli sprouts (the sulforaphane preparation)

• Sprout broccoli seed in a jar: 1-2 tablespoons of seed, rinse twice daily, drain well, 3-5 days until the sprouts are 2-3 cm
• Eat raw. Heat destroys myrosinase, the enzyme that makes sulforaphane available.
• If you cook them or the broccoli, add a pinch of raw mustard powder or grated raw radish to restore myrosinase activity
• Sprouting seed carries a food-poisoning risk; rinse properly and keep the jar draining

Mastic gum

• 350 mg to 1 g of mastic, chewed, has been used in trials
• Chew it rather than swallowing it whole

Honey

• Manuka or ordinary raw honey has in-vitro activity against the organism
• Any effect is on the organism in a dish; honey is not an ulcer treatment
• No honey under 12 months of age

Cranberry

• Juice or a standardised extract, as an adjunct rather than a treatment
• Evidence is for reduced colonisation and it does not eradicate

Cautions and interactions

• A plant compound is not an eradication regimen. Partial suppression selects resistance.
• Honey is sugar. Substantial daily honey for an ulcer is a glycaemic load.
• Raw sprouts are a food-poisoning risk, especially for anyone immunocompromised, pregnant, elderly, or a small child.
• Do not use mastic gum or cranberry with warfarin without checking; both can affect bleeding risk.

When this is not a self-care problem — get help

• Vomiting blood or coffee-ground material, black tarry stool, sudden severe abdominal pain with a rigid abdomen, or fainting — emergency care. A bleeding or perforated ulcer is a surgical emergency.

Related

• Indigestion without an ulcer (functional dyspepsia)
• Reflux and heartburn
• Iron deficiency: the right way to take iron, and the reason it may not be a supplement problem
• Herb-drug interactions: the ones with numbers behind them

Sources

1. Effect of polyphenol compounds on Helicobacter pylori eradication: a systematic review with meta-analysis. BMJ open 2023; doi:10.5009/gnl14040 PubMed 36604137
2. The effect of cranberry supplementation on Helicobacter pylori eradication in H. pylori positive subjects: a systematic review and meta-analysis of randomised controlled trials. The British journal of nutrition 2022; doi:10.1017/S0007114521004256 PubMed 34670631
3. The effect of antioxidants on Helicobacter pylori eradication: A systematic review with meta-analysis. Helicobacter 2018; doi:10.1111/hel.12535 PubMed 30191635
4. Systematic review: are probiotics useful in controlling gastric colonization by Helicobacter pylori? Alimentary pharmacology & therapeutics 2006; doi:10.1111/j.1365-2036.2006.02868.x PubMed 16611267
5. Suppression of Helicobacter pylori infection by daily cranberry intake: A double-blind, randomized, placebo-controlled trial. Journal of gastroenterology and hepatology 2021; doi:10.1111/jgh.15212 PubMed 32783238
6. Effects of probiotics or broccoli supplementation on Helicobacter pylori eradication with standard clarithromycin-based triple therapy. The Korean journal of internal medicine 2020; doi:10.3904/kjim.2019.139 PubMed 31830776