Novel And Emerging Strategies
Silver compounds have antibacterial activity through multiple mechanisms, which lowers the likelihood of microbial resistance. Silver nanoparticles gained attention in recent years as a potential tool in the battle against antibiotic-resistant organisms (Dakal 2016). Utilizing silver compounds to target H. pylori represents one such opportunity.
Laboratory and animal studies indicate silver nanoparticles have anti-H. pylori activity (Amin 2012; Kuo 2014). In one animal model, silver nanoparticles were shown to safely decrease H. pylori densities, with higher silver concentrations having stronger inhibitory effects (Kuo 2014).
Silver nanoparticles could potentially be used to lower H. pylori load, increasing the success of anti-H. pylori therapies. Human studies with longer observation periods are needed before clinical use becomes practical (Kuo 2014).
Note: silver nanoparticles should not be confused with over-the-counter colloidal silver preparations. Silver nanoparticle preparations are used in experimental settings under controlled conditions and have different physicochemical properties than readily available colloidal silver preparations. Colloidal silver preparations have not been demonstrated in published, peer-reviewed studies to have anti-H. pylori activity. In addition, colloidal silver has not been proven effective for treating any condition, and may have several side effects, including argyria—a disorder in which the skin takes on a permanent bluish-gray discoloration (Griffith 2015; NIH 2017).
Liposomal Linolenic Acid
Linolenic acid is a naturally occurring fatty acid found in vegetable oils that has antimicrobial properties. However, under normal conditions in the body, linolenic acid is not soluble and has little antibacterial activity. Liposomal technology overcomes this barrier by incorporating linolenic acid into a complex of cholesterol and phospholipids. This creates microscopic particles called liposomes that fuse with H. pylori cell membranes and efficiently deliver linolenic acid (Thamphiwatana 2014; Jung 2015).
Liposomal linolenic acid has been shown to kill H. pylori and markedly reduce its population in the stomach of mice. In addition, liposomal linolenic acid was shown to decrease levels of pro-inflammatory cytokines triggered by H. pylori (Thamphiwatana 2014).
In mice, liposomal linolenic acid was found to penetrate the gastric mucus layer where H. pylori resides (Allen 1997). A considerable amount of liposomal linolenic acid remained in the stomach lining up to 24 hours later, and no toxic effects of this treatment were observed (Thamphiwatana 2014).
Intermittent Oral Proton-Pump Inhibitor Therapy for Bleeding Ulcers
Acid suppression with PPIs reduces bleeding, although the exact mechanism behind this effect is not well understood. For patients with high-risk bleeding ulcers, current guidelines recommend a single intravenous dose of a PPI followed by continuous PPI infusion for 72 hours after endoscopic treatment. However, according to a review of studies, intermittent treatment with both oral and intravenous PPIs are as effective as continuous infusion of PPIs in patients with high-risk bleeding ulcers. Intermittent PPI therapy (oral or intravenous) has the advantages of easy administration, lower cost, and lower PPI dose than continuous infusion PPI therapy (Sachar 2014). Also, intermittent PPI therapy has been shown to reduce the total amount of PPI used, which may reduce long-term side effects, although this has not been firmly established (Laine 2016).