Baryshnikova NV, Gulunov ZK, Uspenskiy YP. Alpha-glutamyl-tryptophan as adjuvant reparative therapy after Helicobacter pylori eradication in chronic atrophic gastritis: A case report and literature review. World J Pharmacol 2026; 15(2): 120862 [DOI: 10.5497/wjp.120862]
Corresponding Author of This Article
Natalia V Baryshnikova, Department of Molecular Microbiology (named after the Academician A.A. Totolyan), Institute of Experimental Medicine, Pavlova 12A, St. Petersburg 197376, Russia. baryshnikova_nv@mail.ru
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Gastroenterology & Hepatology
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case-report
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Baryshnikova NV, Gulunov ZK, Uspenskiy YP. Alpha-glutamyl-tryptophan as adjuvant reparative therapy after Helicobacter pylori eradication in chronic atrophic gastritis: A case report and literature review. World J Pharmacol 2026; 15(2): 120862 [DOI: 10.5497/wjp.120862]
World J Pharmacol. Sep 16, 2026; 15(2): 120862 Published online Sep 16, 2026. doi: 10.5497/wjp.120862
Alpha-glutamyl-tryptophan as adjuvant reparative therapy after Helicobacter pylori eradication in chronic atrophic gastritis: A case report and literature review
Natalia V Baryshnikova, Zaurbek K Gulunov, Yury P Uspenskiy
Natalia V Baryshnikova, Department of Molecular Microbiology (named after the Academician A.A. Totolyan), Institute of Experimental Medicine, St. Petersburg 197376, Russia
Natalia V Baryshnikova, Zaurbek K Gulunov, Yury P Uspenskiy, Department of Faculty Therapy (named after the professor V.A. Waldman), St. Petersburg State Pediatric Medical University, St. Petersburg 194100, Russia
Author contributions: Baryshnikova NV contributed to study conceptualization, methodology, software, formal analysis, investigation, and supervision; Gulunov ZK contributed to validation; Baryshnikova NV and Gulunov ZK contributed to resources, data curation, and writing of the original draft; Uspenskiy YP contributed to visualization and project administration; all authors have read and approved the final version of the manuscript.
AI contribution statement: Artificial intelligence (AI) tools, specifically ChatGPT, were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated content was critically reviewed and revised by the authors before submission.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Natalia V Baryshnikova, Department of Molecular Microbiology (named after the Academician A.A. Totolyan), Institute of Experimental Medicine, Pavlova 12A, St. Petersburg 197376, Russia. baryshnikova_nv@mail.ru
Received: March 10, 2026 Revised: May 13, 2026 Accepted: May 26, 2026 Published online: September 16, 2026 Processing time: 185 Days and 11.3 Hours
Abstract
BACKGROUND
Gastric mucosal atrophy is widely regarded as a “point of no return” in the Correa cascade and an early step in gastric carcinogenesis. Despite the successful eradication of Helicobacter pylori (H. pylori), atrophic changes of the gastric mucosa may persist and remain irreversible. Early detection of gastric atrophy and timely initiation of therapeutic agents capable of restoring gastric mucosal structure and function are considered essential components of the comprehensive treatment of chronic atrophic gastritis (CAG). A prominent compound of adjuvant reparative therapy is alpha-glutamyl-tryptophan.
CASE SUMMARY
A 45-year-old man with H. pylori-associated CAG presented with abdominal pain rated 4/10, diarrhea occurring 2–3 times daily, and dyspeptic symptoms, including nausea and bloating. Before and after treatment, the patient underwent a comprehensive examination to assess the condition of the gastric mucosa, including upper gastrointestinal endoscopy with biopsy, H. pylori verification, morphological and immunohistochemical analysis of biopsies (stromal cell-derived factor 1 [CXCL-12] and the homeobox protein transcription factor-2 [CDX-2]), blood testing using the GastroPanel diagnostic system, and 24-h pH monitoring of gastric juice. Initial examination confirmed the diagnosis of H. pylori-associated CAG. The patient received standard first-line H. pylori eradication therapy for 10 days, followed by a 28-day course of alpha-glutamyl-tryptophan administered twice daily before meals and at bedtime. Upon completion of treatment, the patient demonstrated complete resolution of clinical symptoms, accompanied by improvement in laboratory and instrumental findings. Endoscopy revealed reduced gastric mucosal edema and hyperemia, consistent with regression of inflammatory activity. Histological examination revealed an increase in gland number (from 14 before treatment to 21 after treatment) and gland depth (from 155.9 to 192.6 µm of gastric mucosa), as well as a rise in the number of parietal cells per 100 epithelial cells (from 0 to 16), indicating a reduction in atrophic changes. Twenty-four-hour pH monitoring demonstrated a marked improvement in gastric acidity, with the mean pH decreasing from 6.8 to 1.2. Immunohistochemical analysis demonstrated a reduction in the relative expression of CDX-2 compared with baseline values (from 12.1% to 7%), indirectly suggesting a decrease in gastric mucosal atrophy. A concomitant decrease in CXCL-12 expression (from 17% to 7.94%) was also observed, which may reflect reduced activity of chronic inflammation and represents a potentially favorable prognostic indicator, as increased CXCL-12 expression has been associated with gastric cancer progression. GastroPanel diagnostic system demonstrated improvements in the levels of pepsinogen I (from 41 μg/L to 155 μg/L) and gastrin-17 (from 41 pmol/L to 1.7 pmol/L).
CONCLUSION
The present clinical case supports a potential role of alpha-glutamyl-tryptophan as adjuvant (or reparative) therapy after H. pylori eradication, with possible effects on gastric mucosal regeneration and reduction of inflammatory activity in H. pylori-associated CAG. Nevertheless, these observations remain preliminary, and further well-designed studies are necessary to confirm efficacy, establish safety, and optimize its use within comprehensive treatment protocols.
Core Tip: The use of alpha-glutamyl-tryptophan as adjuvant reparative therapy following Helicobacter pylori (H. pylori) eradication may represent a promising approach to supporting gastric mucosal recovery and attenuating inflammatory activity in patients with H. pylori-associated chronic atrophic gastritis.
