Potential role of probiotics in the management of gastric ulcer

Abstract

Gastric ulcer is one of the most common chronic gastrointestinal diseases characterized by a significant defect in the mucosal barrier. Helicobacter pylori (H. pylori) infection and the frequent long-term use of non-steroidal anti-inflammatory drugs are major factors involved in gastric ulcer development. Acid inhibitors and antibiotics are commonly used to treat gastric ulcer. However, in the last few decades, the accumulating evidence for resistance to antibiotics and the side effects of antibiotics and acid inhibitors have drawn attention to the possible use of probiotics in the prevention and treatment of gastric ulcer. Probiotics are live microorganisms that when administered in adequate amounts confer health benefits on the host. Currently, the available experimental and clinical studies indicate that probiotics are promising for future applications in the management of gastric ulcers. This review aims to provide an overview of the general health benefits of probiotics on various systemic and gastrointestinal disorders with a special focus on gastric ulcer and the involved cellular and molecular mechanisms: i) Protection of gastric mucosal barrier; ii) upregulation of prostaglandins, mucus, growth factors and anti-inflammatory cytokines; iii) increased cell proliferation to apoptosis ratio; and iv) induction of angiogenesis. Finally, some of the available data on the possible use of probiotics in H. pylori eradication are discussed.

Keywords: Helicobacter pylori; gastric mucosa; gastric mucosal barrier; gastric ulcer; gastric ulcer healing; gastric ulcer prevention; probiotics.

Figure 1.

Summary of gastrointestinal (red), non-gastrointestinal (blue) and neoplastic (green) disorders that are currently known to respond to probiotics.

Figure 2.

Summary of gastric ulcer etiology and different treatment options. Gastric ulcer results from the imbalance between damaging (gastric acidity, pepsin secretion, H. pylori infection and NSAIDS) and defensive factors (bicarbonate and mucus secretion, prostaglandin production, epithelial regeneration, and mucosal blood flow) of the mucosa. Acid inhibitors (e.g., proton pump inhibitors) and antibiotics specific for H. pylori (clarithromycin, amoxicillin/metronidazole) are used routinely for the treatment of gastric ulcer. Experimental studies suggest that probiotics could contribute to the prevention and therapeutic modalities of gastric ulcer by enhancing: i) Production of prostaglandin, mucins, growth factors and anti-inflammatory cytokines, ii) the cellular proliferation-to-apoptosis ratio, iii) gastric mucosal integrity, iv) trans-mucosal resistance and v) angiogenesis. Transplantation of bone marrow mesenchymal stem cells or possibly gastric epithelial stem cells is also a proposed modality for the treatment of gastric ulcers that requires further investigation. H. pylori, Helicobacter pylori; NSAIDs, non-steroidal anti-inflammatory drugs.

Figure 3.

Summary of the proposed main cellular and molecular events involved in the effects of probiotics on gastric ulcer.SOD, superoxide dismutase; CAT, catalase; MDA, malondialdehyde; VEGF, vascular endothelial growth factor; FGF, fibroblast growth factor; TGF, transforming growth factor; EGF, epidermal growth factor; Bax, Bcl-2-associated X protein; Bcl2, B cell lymphoma 2; IgA, immunoglobulin A; PGE2, prostaglandin E2; PGI2, prostaglandin I2; PGF1α, prostaglandin F1α; HSP70, heat-shock protein 70; MUC6, mucin 6; MUC5AC, mucin 5AC.