H. pylori was discovered in April 1982 by two Australian physicians, Dr. Barry Marshall and Dr. Robbin Warren. In 1983 the two doctors proposed that the bacterium is the cause of peptic (duodenal and gastric) ulcers. Dr. Marshall even went so far as to innoculate himself with the bacterium to prove his point(1). The discovery was met by deafening silence from the medical community and created great anxiety within the pharmaceutical industry. At the time, highly profitable antacids such as cimetidine (Tagamet) and ranitidine (Zantac) were used to treat about 90 per cent of all ulcer patients and generated sales income of over $8 billion per year(1,2). Cimetidine and ranitidine do not cure ulcers, but merely mask the symptoms. The relapse rate after cessation of treatment is 50 per cent after six months and as high as 95 per cent after one year(1,3).

Nevertheless, courageous medical researchers took up the challenge and it soon became apparent just how widespread and serious the H. pylori threat is. Not only did research confirm that over 90 per cent of people with peptic ulcers are infected with the bacterium, but it also became clear that H. pylori infections can be eradicated and the vast majority of ulcers cured by a one-week treatment with antibiotics and antibacterials(2,4,5,6,7,8,9).

It is estimated that about three quarters of the world's population suffer from a H. pylori infection(2). The prevalence is highest among the elderly, the poor, and among people living in unhygienic conditions(2,6,10,11). H. pylori can be transferred from person to person and is often transmitted by parents to their children. It usually stays with its host for life unless eradicated(2).

H. pylori has a strong affinity for the lining of the stomach and recent research has shown that it is the main cause of stomach ulcers(1,2,5,6,9); the use of aspirin and nonsteroidal anti-inflammatory drugs is another important cause(12,13). A H. pylori infection is involved in dyspepsia (indigestion), excess stomach acid, gastritis (inflammation of the stomach lining), and stomach cancer(2,3,6,14,15,16,17,18,19). H. pylori has also been implicated in coronary heart disease, hypertension, hives (chronic urticaria), rosacea, and Sjogren's syndrome(2,20,21,22).

There are several simple tests available for diagnosing a H. pylori infection. The [13C]-urea breath test and antibody assays are non-invasive, but an endoscopic biopsy may be required for final diagnosis(3,9,17).

A H. pylori infection can be effectively eradicated by a one-week treatment with tetracycline (or amoxillin), metronidazole (or clarithromycin), and bismuth subsalicylate (or subcitrate); some treatment protocols also include omeprazole(4,6,7,9).

Tetracycline is a common antibiotic with the usual undesirable side effects of this type of drug. Metronidazole is an antibacterial which is particularly effective in treating anaerobic, abdominal infections. It is a very powerful drug with nasty side effects. Bismuth subsalicylate (the active ingredient in Pepto-Bismol) is commonly used to relieve indigestion and heartburn and is relatively innocuous(23).

Omeprazole (Losec) suppresses the formation of stomach acid and is commonly used to alleviate ulcer symptoms. Omeprazole interacts with tranquilizers (diazepam) and anticoagulants (warfarin) and has several unpleasant side effects. Like cimetidine and ranitidine, omeprazole can cause impotence and breast enlargement in men(24,25).

Although the chemical "cocktail" required to eradicate H. pylori is by no means without danger it does do the job. It not only eradicates the bacteria in 90 to 98 per cent of all cases, but also results in a permanent cure for ulcers with a relapse rate of less than five per cent(6).

As a matter of fact, the treatment works so well that the U.S. National Institutes of Health (NIH) in 1994 issued an advisory to all American physicians to discontinue the prescription of cimetidine, omeprazole, and ranitidine for their ulcer patients. Instead, the physicians were advised to treat them with the appropriate regimen of antibiotics, antibacterials, and bismuth compounds to eradicate the H. pylori and permanently cure the ulcers(2).

It would appear that both the medical community and the pharmaceutical industry largely ignored the advice by the NIH to the painful and costly detriment of their patients.

A 1995 survey by an Australian physician showed that less than one per cent of 38,000 war veterans with stomach ulcers were receiving the recommended treatment for their condition (tetracycline, metronidazole, and bismuth subcitrate) (26).

The pharmaceutical industry reacted vigorously to the threat posed by the NIH advice to their $8 billion a year antacid market by making a swift deal with the U.S. Federal Drug Administration (FDA) to allow their antiulcer drugs to be sold without a prescription. With this master stroke the drug companies freed medical doctors from the ethical burden of prescribing ineffective, costly drugs while at the same time maintaining or perhaps even expanding their market among the broad segment of the population who had never heard of H. pylori much less the 1994 NIH advice. Not surprisingly, the drug company executive who negotiated the deal with the FDA was later named one of the 25 most successful business men in a 1995 survey by Business Week(27).

Although the eradication of H. pylori and a complete cure of ulcers can now be accomplished by a one-week treatment with pharmaceutical drugs, there are undoubtedly a great many patients who would rather avoid drugs altogether. For them there is now exciting news from New Zealand. Professor Peter Molan, MBE of the University of Waikato has found that certain strains of Manuka honey are very effective in completely eradicating H. pylori when tested in the laboratory(28). Honey as such has long been known to alleviate dyspepsia and diarrhea and is a very effective wound dressing and antibacterial agent(29,30,31). Manuka honey, however, is unique in its ability to completely eradicate H. pylori and this effect is only found in honey from specific geographic areas(32). A preliminary clinical trial of Manuka honey showed that ulcer patients who took 20 g of honey four times daily, one hour before meals and at bedtime, experienced considerably less pain and discomfort than patients who took a honey with no antibacterial activity. Unfortunately, the preliminary trial had to be terminated early, but another trial is in the planning stage. The protocol of this trial will be modified by including a slice of bread with the honey in order to increase the retention time in the stomach(32).

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