Helicobacter pylori (H.pylori) is the most common bacterial infection worldwide, colonising the gastrointestinal tract of more than 50% of the global population. Colonisation with H. pylori is not a disease in itself, but a condition that affects the relative risk of developing various clinical disorders of the upper gastrointestinal tract. Most infected people remain asymptomatic, however, up to 20% of H. pylori infections will ultimately develop into chronic gastritis, peptic ulceration, mucosa-associated lymphoid tumours, or even gastric adenocarcinoma.¹

Classical first-line treatment of patients diagnosed with H. pylori infection involves the use of triple therapy (concomitant prescription of two antibiotics and a proton pump inhibitor). Quadruple therapy (concomitant prescription of three antibiotics and a proton-pump inhibitor) is a second-line treatment approach. However, H. pylori eradication rates following these standard regimes are generally poor due to antimicrobial resistance and patient non-compliance.²

Several non-antibiotic treatments have been investigated as potential adjuvants for the treatment of H. pylori, one of which is vitamin C.³

Table 1. Mechanisms of action of vitamin C against H. pylori.^4,5    

     

A large number of population-based surveys have shown that higher serum levels of vitamin C are associated with a decreased prevalence of H. pylori.6 Multiple studies have also reported significant improvement in H. pylori eradication rates when vitamin C was supplemented either alone^7,8 or alongside standard antibiotic treatment.^9-13 Effective dosage regimes ranged from 50 mg to 5 g of vitamin C daily.

These findings reiterate the importance of Vitamin C as a fundamental component in improving outcomes for eradicating H. pylori infection.  Practitioners should therefore consider the following oral vitamin C supplementation regime in those individuals presenting with H. pylori infection:

• 500-1000 mg ascorbic acid daily for a minimum of 2 weeks as an adjunct to antibiotic treatment.
• 5000 mg ascorbic acid daily for a minimum of 4 weeks as an adjunct to antacid therapy.
• 500 mg ascorbic acid daily long term as a preventative measure.

 

 

References

1. Kusters, J.G., A.H.M. van Vliet, and E.J. Kuipers, Pathogenesis of Helicobacter pylori infection. Clinical Microbiology Reviews, 2006. 19(3): p. 449-490.
2. Ayala, G., et al., Exploring alternative treatments for Helicobacter pylori infection. World Journal of Gastroenterology, 2014. 20(6): p. 1450-1469.
3. Kassem, A., S.A. El-Zahaby, and A. El-kamel, Non-antibiotic Therapies for Treatment of Helicobacter pylori Infection. Vol. 2016. 2016. 1-5.
4. Carr, A.C. and S. Maggini, Vitamin C and Immune Function. Nutrients, 2017. 9: p. 1211.
5. Hussain, A., et al., Vitamin C: A Preventative, Therapeutic Agent Against Helicobacter pylori. Cureus, 2018. 10(7): p. e3062-e3062.
6. Mei, H. and H. Tu, Vitamin C and Helicobacter pylori Infection: Current Knowledge and Future Prospects. Front Physiol, 2018. 9: p. 1103.
7. Sezikli, M., et al., Effects of Alpha Tocopherol and Ascorbic Acid on Helicobacter pylori Colonization and the Severity of Gastric Inflammation. Helicobacter, 2012. 17(2): p. 127-132.
8. Sasazuki, S., et al., The effect of 5-year vitamin C supplementation on serum pepsinogen level and Helicobacter pylori infection. Cancer Science, 2003. 94(4): p. 378-382.
9. Chuang, C.H., et al., Adjuvant effect of vitamin C on omeprazole-amoxicillin-clarithromycin triple therapy for Helicobacter pylori eradication. Hepatogastroenterology, 2007. 54(73): p. 320-4.
10. Zojaji, H., et al., The efficacy of Helicobacter pylori eradication regimen with and without vitamin C supplementation. Dig Liver Dis, 2009. 41(9): p. 644-7.
11. Sezikli, M., et al., Oxidative stress in Helicobacter pylori infection: does supplementation with vitamins C and E increase the eradication rate? Helicobacter, 2009. 14(4): p. 280-5.
12. Sezikli, M., et al., Supplementing vitamins C and E to standard triple therapy for the eradication of Helicobacter pylori. J Clin Pharm Ther, 2012. 37(3): p. 282-5.
13. Sezikli, M., et al., Efficacy of vitamins supplementation to therapy on Helicobacter pylori eradication in patients with low antioxidant capacity. Clin Res Hepatol Gastroenterol, 2011. 35(11): p. 745-9.