N-ACETYLCYSTEINE IMPROVES ERADICATION OF HELICOBACTER-PYLORI BY OMEPRAZOLE AMOXICILLIN IN CIGARETTE SMOKERS/

Colonization of Helicobacter pylori (HP) beneath the protective film o f gastric mucus enables the organism to survive in the hostile environ ment of the gastric mucosa. N-acetylcysteine (NAC), a sulfhydryl compo und with potent mucolytic activity, induces a reduction of gastric bar rier mucus thickness of about 75% and reduces mucus viscoelasticity. W e therefore tested the hypothesis whether better eradication results c ould be achieved by addition of NAC to omeprazole/amoxicillin (OME/AMO X). 34 HP positive outpatients with endoscopically documented recurren t duodenal ulcer were included in an ongoing, prospective, randomized trial. Exclusion criteria were: alcoholism, previous gastric surgery, or intake of antibiotics, OME, bismuth salts, corticosteroids or NSAID s within 4 weeks before study entry. Patients currently smoking >10 ci garettes/day were classified as smokers. HP infection was confirmed by histology (3 biopsy specimens from gastric antrum and 2 from gastric body; H&E, Giemsa) and at least positive rapid urease test or culture. All 34 patients underwent ulcer therapy with OME (20 mg per day) for 20 days (d 1-20). Group A: in 17 patients (5 females, 12 males, mean a ge 46 [29-74] years; 8 smokers, 9 nonsmokers) the subsequent eradicati on therapy, consisting of oral OME (40 mg bid) and AMOX solute (750 mg tid) for 10 days, was combined with NAC solute (2x600 mg bid (d 21-30 ). Group B: 17 patients (2 females, 15 males, mean age 39 [19-70] year s; 11 smokers, 6 nonsmokers) underwent eradication therapy without NAC (d 21-30). Control endoscopy was done after a minimal interval of 30 days from the end of treatment. Criteria for eradication were negative CLO, failure to culture HP and failure to visualize HP in histology o f 3 antral and 2 gastric body biopsies. Eradication rates with and wit hout NAC were 12/17 (71%) and 7/17 (41%) respectively (ns). Equal rate s were obtained in nonsmokers, regardless of whether or not NAC was ad ded (6/9 [67%] vs 4/6 [67%]). In smokers, however, addition of NAC sho wed an evident tendency to improve eradication rates (6/8 [75%] with N AC vs 3/11 [27%] without NAC, p = 0.10). NAC was found to increase the impaired eradication rate by OME/AMOX in cigarette smokers without in fluencing the results obtained in nonsmokers. This indicates that the beneficial effect of NAC was not due to the global mucolytic activity of the substance and in general improvement of local availability of a ntibiotics to HP. NAC seems rather to interfere with probably radical- mediated mechanisms occurring in smokers, which inhibit eradication of HP by OME/AMOX. Combination of NAC with OME/AMOX appears to represent a promising way, without side effects, to improve the poor eradicatio n results obtained in cigarette smokers by OME/AMOX alone.