Fermented milk product “Narineh” with Lactobacillus acidophilus in sequential and classical therapy for Helicobacter pylori-associated peptic ulcers

Background: In recent years, there has been a growing dissatisfaction with the classical schemes of the eradication of Helicobacter pylori in ulcerative disease among physicians due to frequent failures in eradication therapy, mostly due to antibiotic resistance. It is a known fact that the Lactobacillus acidophilus inhibits the growth of Helicobacter pylori.  Objective: Our main goal was to investigate the ability of the fermented milk product "Narineh,” as a functional food, containing Lactobacillus acidophilus to evaluate the efficiency and incidence of adverse effects in addition to the standard triple scheme of eradication therapy with colloidal bismuth substrate.  Methods: The patients with peptic ulcer were divided into 2 groups: control (42 patients) received traditional treatment regimens, including 7 days proton pump inhibitor (PPI) + amoxicillin (A) and clarithromycin (C) in the standard doses and subsequent 14 day De-nol (colloidal bismuth subcitrate); experimental (44 patients) received in addition to this standard  conventional scheme "Narineh" - 200g, containing 2x109 Lactobacillus acidophilus one time a day starting from the 8-th day for 4 weeks. The results of the eradication in patients were evaluated after 4 -5 weeks, 6 months, and 12 months after completion of treatment using the C13 respiratory urea test (RUT). Repeated endoscopy with histological biopsies was carried out together with RUT in 4-5 weeks after the completion of treatment, and later (6-12 months) for the identification of recurrent ulcer.  Results: The treatment with “Narineh” added to the standard regimen significantly reduces the percentage of reinfection and relapse of the disease with a statistical difference (P<0,05). The combination of fermentation milk product “Narineh”, containing Lactobacillus acidophilus with bismuth subcitrate, doesn’t cause a violation of biocenosis of the large intestine, in contrast to the PPI and antibiotics with a statistical difference (P<0,05). In addition, it provides the normalization of gut biocenosis and reduces the frequency of antibiotic-associated diarrhea and other side effects.   Conclusion: The treatment with “Narineh” added to the standard scheme is more effective for eradication of Helicobacter pylori infection and significantly reduces the percentage of reinfection and relapse of the disease and lessens the side effects of medications.   Keywords: peptic ulcer, eradication Helicobacter pylori, side effects reinfection, fermented milk product “Narineh”, Lactobacillus acidophilus, functional foods