The effects of N-acetylcysteine and tocopherol in combination with standard therapy for helicobacter pylori infection

Although Helicobacter pylori (H. pylori) had been identified at the beginning oftwentieth century, its association with peptic ulcer, chronic gastritis and gastricadenocarcinoma has been known only since 1983. Untreated H. pylori infection cancause chronic atrophic gastritis, peptic ulcer disease, gastric adenocarcinoma andprimary gastric B-cell lymphoma (MALToma). For this reason, eradication of H. pylorihas become an important issue. In recent years, failure of eradication therapy hasdirected studies towards new therapeutic alternatives. In our study, we aimed toinvestigate the effect of combining standard eradication therapy with N-acetylcysteine(NAC) or tocopherol on eradication rates in patients with peptic ulcer or erosion.A total of 100 consecutive patients with gastric ulcer, duodenal ulcer orduodenitis were enrolled into the study. The histological gastritis characteristics of 99patients, in whom H. pylori was detected in gastric biopsies, were determinedaccording to Sydney classification. All patients were divided into 4 groupsconsecutively. Group 1 accepted triple therapy with lansoprazole 30 mg, amoxicillin1000 mg and clarithromycin 500 mg twice a day for 14 days. In group 2, NAC 600 mgtwice a daily was added to the triple therapy, in group 3 tocopherol 200 Ü, and group4 both NAC 600 mg and tocopherol 200 Ü. A total of 6 patients were excludedbecause of an incomplete therapy due to nausea, vomiting or abdominal pain, ordeath for any reason. In the remaining 93 patients, H. pylori stool antigen (HpSA)was tested at the eighth week after the triple therapy initiation. In HpSA negativepatients, eradication therapy was accepted successful. We did not find any increasein success rate of eradication treatment after adding NAC and/or tocopherol to thetriple therapy, despite eradication rate was higher, but not significant, in tocopherolgroup. We found a higher eradication rates in patients with lower H. pylori densityand severity of chronic inflammation.In conclusion, further studies with new therapeutic agents as well astocopherol in larger patient populations need to be conducted, especially whenresistance to H pylori eradication therapy is taken into consideration.