Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.724
Revised: November 9, 2013
Accepted: December 5, 2013
Published online: January 21, 2014
Helicobacter pylori (H. pylori) eradication is considered a necessary step in the management of peptic ulcer disease, chronic gastritis, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. Standard triple therapy eradication regimens are inconvenient and achieve unpredictable and often poor results. Eradication rates are decreasing over time with increase in antibiotic resistance. Fermented milk and several of its component whey proteins have emerged as candidates for complementary therapy. In this context the current review seeks to summarize the current evidence available on their role in H. pylori eradication. Pertinent narrative/systematic reviews, clinical trials and laboratory studies on individual components including fermented milk, yogurt, whey proteins, lactoferrin, α-lactalbumin (α-LA), glycomacropeptide and immunoglobulin were comprehensively searched and retrieved from Medline, Embase, Scopus, Cochrane Controlled Trials Register and abstracts/proceedings of conferences up to May 2013. A preponderance of the evidence available on fermented milk-based probiotic preparations and bovine lactoferrin suggests a beneficial effect in Helicobacter eradication. Evidence for α-LA and immunoglobulins is promising while that for glycomacropeptide is preliminary and requires substantiation. The magnitude of the potential benefit documented so far is small and the precise clinical settings are ill defined. This restricts the potential use of this group as a complementary therapy in a nutraceutical setting hinging on better patient acceptability/compliance. Further work is necessary to identify the optimal substrate, fermentation process, dose and the ideal clinical setting (prevention/treatment, first line therapy/recurrence, symptomatic/asymptomatic, gastritis/ulcer diseases etc.). The potential of this group in high antibiotic resistance or treatment failure settings presents interesting possibilities and deserves further exploration.
Core tip: Treatment regimens for Helicobacter are cumbersome, prone to side effects and often have low success rates. Fermented milk and related proteins have often been explored as potential candidates for complementary therapy. The current review sought to summarize the current evidence available on their role in Helicobacter pylori eradication and found substantial evidence to support the use of fermented milk based probiotic preparation and bovine lactoferrin. Evidence for other whey proteins is preliminary and requires substantiation. Further work is necessary to identify the optimal substrate, fermentation process, dose and the ideal clinical setting. The potential of this group in antibiotic resistance or treatment failure settings also presents interesting possibilities.