Kerbala Journal of Pharmaceutical Sciences. No.

(15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

Response to Helicobacter pylori Eradication Triple Therapy in Peptic Ulcer

Disease Patients on Curcumin Supplement According to different ABO
Phenotypes
Shaymaa Hasan Abbas1
Manal Khalid Abdulridha1‫٭‬
Akram Ajeel Najeb2
1 Departmentof Clinical Pharmacy/College of Pharmacy/Al-Mustansiriya University, Baghdad, Iraq
Email shaymaamustafa8@ uomustansiriyah.edu.iq
1‫٭‬Department of Clinical Pharmacy/College of pharmacy/Al-Mustansiriyah University, Baghdad, Iraq

Email pharm.mrdha@uomustansiriyah.edu.iq
2
Consultant Gastroenterologist, Baghdad Teaching Hospital, Medical city, Iraq.

Abstract

Background: Helicobacter pylori infection is one of the most predominant causes of peptic
ulcer disease. There was a correlation between H. pylori infection and ABO phenotypes in peptic
ulcer disease patients. Curcumin has anti- H. pylori effect due to its anti-oxidant, anti-
inflammatory, anti- microbial, and anti-carcinogenic effect.
Patients and Methods: This study is a prospective randomized interventional open-label study
which designed to show the potential benefit of adjuvant curcumin therapy in peptic ulcer
disease Iraqi patients with different ABO phenotypes. The patients were allocated into two
groups, group (1) treated with standard triple H. pylori eradication, and group (2) treated with
curcumin capsules as adjuvant with the standard triple therapy for two weeks. The ABO
phenotypes detected by Anti ABO and Anti-D monoclonal kit and the H. pylori infection was
detected at the baseline and after 6 weeks of completion treatment course.
Results: highly significant improvement in H. pylori eradication after addition adjuvant curcumin
to standard H. pylori eradication triple therapy compared to standard triple therapy alone(P<0.01)
for patients holding blood group AB phenotypes ( P<0.01) and significant improvement for
patients holding blood group O phenotypes( P<0.05) reach up to (100 %) after 6 weeks from the
intervention starting point. Besides, there was improvement in H. pylori eradication for patients
holding blood group A and B phenotypes with adjuvant curcumin therapy, though no significant
(P>0.05). This study showed no significant difference in BMI among ABO phenotypes (A,B,
AB, and O) for both groups 1 and 2 patients after 6 weeks from the intervention starting
point(P>0.05).

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 ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ )‪Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15‬‬

‫‪Conclusion: Use of adjuvant curcumin with standard triple therapy produced improvement in‬‬
‫‪H. pylori eradication for all patients with different ABO phenotypes. Also, use of curcumin with‬‬
‫‪triple therapy produced non significant increase in BMI compared to triple therapy alone among‬‬
‫‪different ABO blood groups patients.‬‬
‫‪Keywords: Peptic ulcer disease, Helicobacter pylori infection, Curcumin, Triple therapy‬‬

‫ﺍﻻﺳﺗﺟﺎﺑﺔ ﻟﻠﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﺍﻟﻣﺛﺑﻁ ﻟﻠﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ ﻣﻊ ﻣﻛﻣﻼﺕ ﺍﻟﻛﺭﻛﻣﻳﻥ ﻓﻲ ﻣﺭﺿﻰ ﺍﻟﻘﺭﺣﺔ ﺍﻟﻬﺿﻣﻳﺔ‬
‫ﻭﻓ ًﻘﺎ ﻟﻔﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻟﻣﺧﺗﻠﻔﺔ‬
‫ﺷﻴﻤﺎء ﺣﺴﻦ ﻋﺒﺎﺱ‬
‫ﻓﺮﻉ ﺍﻟﺼﻴﺪﻟﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ‪ /‬ﻛﻠﻴﺔ ﺍﻟﺼﻴﺪﻟﺔ‪ /‬ﺍﻟﺠﺎﻣﻌﺔ ﺍﻟﻤﺴﺘﻨﺼﺮﻳﺔ‪/‬ﺑﻐﺪﺍﺩ‪ -‬ﺍﻟﻌﺮﺍﻕ‬
‫ﻣﻨﺎﻝ ﺧﺎﻟﺪ ﻋﺒﺪ ﺍﻟﺮﺿﺎ‬
‫ﻓﺮﻉ ﺍﻟﺼﻴﺪﻟﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ‪ /‬ﻛﻠﻴﺔ ﺍﻟﺼﻴﺪﻟﺔ‪ /‬ﺍﻟﺠﺎﻣﻌﺔ ﺍﻟﻤﺴﺘﻨﺼﺮﻳﺔ‪ /‬ﺑﻐﺪﺍﺩ‪-‬ﺍﻟﻌﺮﺍﻕ‬
‫ﺍﻛﺮﻡ ﻋﺠﻴﻞ ﻧﺠﻴﺐ‬
‫ﻭﺣﺪﺓ ﺍﻟﻨﻮﺍﻅﻴﺮ‪ /‬ﻣﺴﺘﺸﻔﻰ ﺑﻐﺪﺍﺩ ﺍﻟﺘﻌﻠﻴﻤﻲ‪ /‬ﺩﺍﺋﺮﺓ ﻣﺪﻳﻨﺔ ﺍﻟﻄﺐ ‪/‬ﺑﻐﺪﺍﺩ‪ -‬ﺍﻟﻌﺮﺍﻕ‬
‫ﺍﻟﻜﻠﻤﺎﺕ ﺍﻟﻤﻔﺘﺎﺣﻴﺔ‪ :‬ﺍﻟﻘﺮﺣﻪ ﺍﻟﻬﻀﻤﻴﻪ ‪,‬ﺍﻟﻌﺪﻭﻯ ﺍﻟﻤﻠﻮﻳﻪ ﺍﻟﺒﻮﺍﺑﻴﻪ ‪ ,‬ﺍﻟﻜﺮﻛﻤﻴﻦ ‪ ,‬ﻓﺼﺎﺋﻞ ﺍﻟﺪﻡ‬
‫ﺍﻟﺧﻼﺻﺔ‬

‫ﺍﻟﺧﻠﻔﻳﺔ‪ :‬ﺗﻌﺩ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ ﻭﺍﺣﺩﺓ ﻣﻥ ﺍﻛﺛﺭ ﺍﻷﺳﺑﺎﺏ ﺍﻧﺗﺷﺎﺭﺍ ﻟﻣﺭﺽ ﺍﻟﻘﺭﺣﺔ ﺍﻟﻬﺿﻣﻳﺔ‪ .‬ﺣﻳﺙ ﻫﻧﺎﻟﻙ‬
‫ﺍﺭﺗﺑﺎﻁ ﺑﻳﻥ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ ﻭﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ) ‪(ABO‬ﻓﻲ ﻣﺭﺿﻰ ﺍﻟﻘﺭﺣﺔ ﺍﻟﻬﺿﻣﻳﺔ‪ .‬ﻭﻗﺩ ﺗﺑﻳﻥ ﺃﻥ ﺳﺭﻁﺎﻥ‬
‫ﺍﻟﻣﻌﺩﺓ ﻛﺎﻥ ﻣﺭﺗﺑﻁﺎ ﻣﻊ ﻓﺻﻳﻠﺔ ﺍﻟﺩﻡ ‪ A‬ﻓﻲ ﺣﻳﻥ ﺃﻥ ﻗﺭﺣﺔ ﺍﻻﺛﻧﻲ ﻋﺷﺭ ﻛﺎﻧﺕ ﻣﺭﺗﺑﻁﺔ ﺑﺎﻟﻣﺭﺿﻰ ﺍﻟﺣﺎﻣﻠﻳﻥ ﻟﻔﺻﻳﻠﺔ‬
‫ﺍﻟﺩﻡ‪ .O‬ﻳﻌﺩ ﺍﻟﻛﺭﻛﻣﻳﻥ‬

‫ﺫﻭ ﺗﺄﺛﻳﺭﻣﺿﺎﺩ ﻟﻠﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ ﺑﺳﺑﺏ ﺗﺄﺛﻳﺭﻩ ﻛﻣﺿﺎﺩ ﻟﻸﻛﺳﺩﺓ ﻭ ﻣﺿﺎﺩ ﻷﻟﺗﻬﺎﺑﺎﺕ ﻭﻣﺿﺎﺩ ﻟﻠﻣﻳﻛﺭﻭﺑﺎﺕ‬
‫ﻭﻣﺿﺎﺩ ﻟﻠﺳﺭﻁﺎﻥ‪.‬‬

‫ﺍﻟﻣﺭﺿﻰ ﻭﻁﺭﻳﻘﺔ ﺍﻟﻌﻣﻝ‪ :‬ﺻﻣﻣﺕ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﻛﺩﺭﺍﺳﺔ ﻋﺷﻭﺍﺋﻳﺔ ﻣﺗﺩﺍﺧﻠﺔ ﻣﻔﺗﻭﺣﺔ ﺍﻟﺗﺳﻣﻳﺔ ﻹﻅﻬﺎﺭ ﺍﻟﻔﺎﺋﺩﺓ‬
‫ﺍﻟﻣﺣﺗﻣﻠﺔ ﻣﻥ ﻋﻼﺝ ﺍﻟﻛﺭﻛﻣﻳﻥ ﺍﻟﻣﺳﺎﻋﺩ ﻓﻲ ﺍﻟﻣﺭﺿﻰ ﺍﻟﻌﺭﺍﻗﻳﻳﻥ ﺍﻟﻣﺻﺎﺑﻳﻥ ﺑﺎﻟﻘﺭﺣﺔ ﺍﻟﻬﺿﻣﻳﺔ ﺍﻟﺣﺎﻣﻠﻳﻥ ﻟﻔﺻﺎﺋﻝ ﺩﻡ‬
‫ﻣﺧﺗﻠﻔﺔ‪ .‬ﻗﺳﻡ ﺍﻟﻣﺭﺿﻰ ﺇﻟﻰ ﻣﺟﻣﻭﻋﺗﻳﻥ ‪ ،‬ﻋﻭﻟﺟﺕ ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻻﻭﻟﻰ ﺑﺎﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﺍﻟﻘﻳﺎﺳﻲ ﺍﻟﻘﺎﺿﻲ ﻋﻠﻰ‬
‫ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ‪ ،‬ﻭﻋﻭﻟﺟﺕ ﺍﻟﻣﺟﻣﻭﻋﺔ ﺍﻟﺛﺎﻧﻳﺔ ﺑﻛﺑﺳﻭﻻﺕ ﺍﻟﻛﺭﻛﻣﻳﻥ ﻛﻣﺳﺎﻋﺩ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﺍﻟﻘﻳﺎﺳﻲ‬
‫ﻭﻟﻣﺩﺓ ﺃﺳﺑﻭﻋﻳﻥ ‪.‬ﻛﺷﻑ ﻋﻥ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺑﻭﺍﺳﻁﺔ ‪ Anti ABO‬ﻭ ‪ Anti-D monoclonal kit‬ﻭ ﺷﺧﺻﺕ ﺍﻟﻌﺩﻭﻯ‬
‫ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ ﻗﺑﻝ ﺍﻟﻌﻼﺝ ﻭﺑﻌﺩ ‪ 6‬ﺃﺳﺎﺑﻳﻊ ﻣﻥ ﺇﻛﻣﺎﻝ ﺍﻟﻌﻼﺝ‪.‬‬

‫ﺍﻟﻧﺗﺎﺋﺞ‪:‬ﺍﻅﻬﺭﺕ ﺍﻟﺩﺭﺍﺳﺔ ﺗﺣﺳﻥ ﻛﺑﻳﺭ ﻓﻲ ﺍﻟﻘﺿﺎء ﻋﻠﻰ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﺔ ﺍﻟﺑﻭﺍﺑﻳﺔ ﺑﻌﺩ ﺇﺿﺎﻓﺔ ﺍﻟﻛﺭﻛﻣﻳﻥ ﻛﻣﺳﺎﻋﺩ‬
‫ﻟﻠﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﺍﻟﻘﻳﺎﺳﻲ ﻣﻘﺎﺭﻧﺔ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﺍﻟﻘﻳﺎﺳﻲ ﻟﻭﺣﺩﻩ )‪ (P <0.01‬ﻓﻲ ﺍﻟﻣﺭﺿﻰ ﺍﻟﺫﻳﻥ ﻳﺣﻣﻠﻭﻥ‬
‫ﻓﺻﻳﻠﺔ ﺍﻟﺩﻡ ‪ AB‬ﻭﺗﺣﺳﻥ ﻣﻠﺣﻭﻅ ﻓﻲ ﺍﻟﻣﺭﺿﻰ ﺍﻟﺣﺎﻣﻠﻳﻥ ﻟﻔﺻﻳﻠﺔ ﺍﻟﺩﻡ ‪ (P <0.05) O‬ﺗﺻﻝ ﺇﻟﻰ )‪ (٪ 100‬ﺑﻌﺩ‬
‫‪ 6‬ﺃﺳﺎﺑﻳﻊ ﻣﻥ ﺑﺩﺍﻳﺔ ﺍﻟﻌﻼﺝ‪ .‬ﻛﺫﻟﻙ ﻛﺎﻥ ﻫﻧﺎﻙ ﺗﺣﺳﻥ ﻓﻲ ﺗﺛﺑﻳﻁ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﻪ ﺍﻟﺑﻭﺍﺑﻳﻪ ﻟﻠﻣﺭﺿﻰ ﺍﻟﺣﺎﻣﻠﻳﻥ ﻟﻔﺻﺎﺋﻝ‬
‫ﺍﻟﺩﻡ ‪A‬ﻭ ‪ B‬ﻣﻊ ﻋﻼﺝ ﺍﻟﻛﺭﻛﻣﻳﻥ ﺍﻟﻣﺳﺎﻋﺩ‪ ،‬ﻭﺇﻥ ﻟﻡ ﻳﻛﻥ ﻣﻌﻧﻭﻳﺎ )‪ .(P> 0.05‬ﺃﻅﻬﺭﺕ ﺍﻟﺩﺭﺍﺳﺔ ﻋﺩﻡ ﻭﺟﻭﺩ ﻓﺭﻕ‬

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

6 ‫(ﻟﻠﻣﺟﻣﻭﻋﺗﻳﻥ ﺍﻻﻭﻟﻰ ﻭﺍﻟﺛﺎﻧﻳﻪ ﺑﻌﺩ‬O ،AB ،B ، A) ‫ﻣﻌﻧﻭﻱ ﻓﻲ ﻣﺅﺷﺭ ﻛﺗﻠﺔ ﺍﻟﺟﺳﻡ ﺑﻳﻥ ﺟﻣﻳﻊ ﻓﺻﺎﺋﻝ ﺍﻟﺩﻡ‬
.(P> 0.05)‫ﺃﺳﺎﺑﻳﻊ ﻣﻥ ﻧﻘﻁﺔ ﺑﺩﺍﻳﺔ ﺍﻟﻌﻼﺝ‬

‫ ﺍﺳﺗﺧﺩﺍﻡ ﺍﻟﻛﺭﻛﻣﻳﻥ ﻛﻣﺳﺎﻋﺩ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﺍﻟﻘﻳﺎﺳﻲ ﻳﺣﺳﻥ ﺍﻟﻘﺿﺎء ﻋﻠﻰ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﻪ ﺍﻟﺑﻭﺍﺑﻳﻪ‬:‫ﺍﻟﺧﻼﺻﺔ‬
‫ ﺍﺳﺗﺧﺩﺍﻡ ﺍﻟﻛﺭﻛﻣﻳﻥ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﻳﻧﺗﺞ‬، ‫ ﺑﺎﻻﺿﺎﻓﺔ ﺍﻟﻰ ﺫﻟﻙ‬.‫ﻟﺟﻣﻳﻊ ﺍﻟﻣﺭﺿﻰ ﺍﻟﺣﺎﻣﻠﻳﻥ ﻟﻔﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻟﻣﺧﺗﻠﻔﻪ‬
.‫ﺯﻳﺎﺩﺓ ﻏﻳﺭ ﻛﺑﻳﺭﺓ ﻓﻲ ﻣﺅﺷﺭ ﻛﺗﻠﺔ ﺍﻟﺟﺳﻡ ﻣﻘﺎﺭﻧﺔ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ ﻭﺣﺩﻩ ﻟﻠﻣﺭﺿﻰ ﺍﻟﺣﺎﻣﻠﻳﻥ ﻟﻔﺻﺎﺋﻝ ﺍﻟﺩﻡ ﺍﻟﻣﺧﺗﻠﻔﺔ‬

‫ ﺍﻟﻌﻼﺝ ﺍﻟﺛﻼﺛﻲ‬، ‫ ﺍﻟﻛﺭﻛﻣﻳﻥ‬،‫ ﺍﻟﻌﺩﻭﻯ ﺍﻟﻣﻠﻭﻳﻪ ﺍﻟﺑﻭﺍﺑﻳﻪ‬، ‫ ﻣﺭﺽ ﺍﻟﻘﺭﺣﺔ ﺍﻟﻬﺿﻣﻳﺔ‬:‫ﺍﻟﻛﻠﻣﺎﺕ ﺍﻟﺭﺋﻳﺳﻳﺔ‬
Introduction
Peptic ulcer disease still one of the main prevalent unresolved medical problems affecting
numerous patients of both genders in a wide range of age worldwide[1]. There are several
predisposing factors for PUD that may be involved in the pathogenesis of the disease.
Helicobacter pylori infection is one of the most predominant causes of PUD. Approximately all
the DUs and up to two-thirds of the GUs reveal positive H. pylori infection[2]. At least 50% of
the population worldwide are infected by H. pylori[3]. Although H. pylori is known to produce
an extensive, non-invasive inflammatory reaction in the gastric mucosa[4]. Colonization of the
stomach with H. pylori often causes an inflammation of the stomach lining that may evolve
toward chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue (MALT)
1`lymphoma, and gastric cancer[5,6].

There was a correlation between H. pylori infection and ABO phenotypes in peptic ulcer
disease patients diagnosed by upper gastrointestinal endoscopy[7]. Eradication of H. pylori
decrease the recurrence of peptic ulcer disease (both gastric and duodenal ulcers), improves
healing rates for duodenal ulcers, and prevents recurrent ulcer haemorrhge[8]. Increasing
difficulties in the conventional H. pylori eradication triple-therapy due to antimicrobial
resistance, undesirable side effects, incomplete cure, cost of the antibiotic regimens,
noncompliance among the patients, and few other factors, promote a critical need to develop new
non-antibiotic antibacterial agents to eradicate H. pylori that are safe, highly effective, low cost
and have specific cellular targets[9]. Experimentally, combination of herbal medicines with
standard antiulcer drugs produced a synergistic effect against peptic ulcer disease, and could be
used as an alternative therapy for treating certain gastric ulcer and preventing recurrence[10].
Curcumin is a yellow pigment extracted from rhizome of Curcuma longa (C. Longa) used
commonly as a spice and food-coloring agent[11]. It is a lipophilic polyphenol, is nearly

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

insoluble in water, but is quite stable at acidic pH of stomach[12]. Curcumin is widely used in
herbal medicine because it possess many pharmacological properties[13]. Curcumin display
antiulcer activity by attenuating different ulcerative effectors including gastric acid
hypersecretion, myeloperoxiase activity, total peroxides, IL-6, and apoptotic incidence, along
with its inhibitory activity for pepsin[14]. Curcumin has anti- H. pylori effect due to its anti-
oxidant, anti-inflammatory, anti- microbial, and anti-carcinogenic effect[15].

PATIENTS AND METHODS

Study design:
The present study is a prospective randomized interventional open-label study which
designed to show the potential benefit of adjuvant curcumin therapy in PUD patients with
different ABO phenotypes who attended the Endoscopy unit of Baghdad Teaching
Hospital/Medical City. The study was conducted between November 2015 up to June 2016.
Patients:
Forty two patients (27 female and 15 male) were enrolled in this study with age range
between (17-70) years. Patients were enrolled in the study after signing a written consent, the
ethical approval was released by scientific committee of the hospital.
Patients were allocated into two groups, group (1) include (20) patients treated with
standard triple H. pylori eradication therapy [clarithromycin (500 mg) tablets (Limassol ,Cyprus)
+ esomeprazole (20mg) tablets (Astrazeneca , Sweden) + amoxicillin (1g) capsules (Bristol,
UK)] all to be given twice daily for two weeks duration, which represent the control group, and
group2 include (22) patients treated with curcumin (500mg) capsules given three times daily for
two weeks as adjuvant with the standard triple H. pylori eradication therapy[15], which
represents the interventional group.

Methods:
Diagnosis of Helicobacter pylori infection: The H. pylori antigen rapid test device (feces)
(ABON, China) is used for detection of H. pylori in both group 1 and 2 patients at the baseline
and after 6 weeks of completion treatment course.
Detection of ABO phenotypes

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

Anti ABO and Anti-D monoclonal kit (Spinreact, Spain) is used for detection of different
ABO phenotypes in both group 1 and 2 patients.

Statistical analysis
The (SPSS) system was used for statistical analysis. Different tests were used for
comparison between study parameters, where data expressed as percent and (mean ± SD) and
considered not significant if (P > 0.05), significant if (*p< 0.05), and highly significant if (**P<
0.01). Paired t-test was utilized to compare between the pre- and post- treatment variable, and
two sample t-test was utilized to compare the pre or post treatment variable between group1 and
group 2.

RESULTS

- Demographic and disease characteristics of H. pylori infected patients

Table (1) demonstrates the demographic and disease characteristic for (42) H. pylori
positive patients including 27 female (64.29%) and 15 male gender (35.71%) with age range 17-
70 year. No significant statistical difference was found between both study groups in respect to
age, body mass index (BMI), genders, family history, Smoking habit, duration of symptoms, and
Rh factor phenotype (P>0.05).

Demographic and disease characteristics of H. pylori infected patients

Variable Study groups P value
Group1( n=20) Group2( n=22)

Age(years): 39.40 ± 11.77 44.36 ± 15.11

0.245 N.S
Range(years): 20-63 17-70

BMI kg/m² 26.89±5.27 26.54±4.22 0.816 N.S

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

n % n %
Gender:

Female 12 60 15 68.18
0.58 N.S
Male 8 40 7 31.82

Family history

positive 2 10 3 13.64
0.714 N.S
Negative 18 90 19 86.36

Duration of symptoms:
< 1 (years) 15 75 11 50
0.083 N.S
1- 5 (years) 5 25 11 50
> 5 ( years) - - - -
Smoking habit
Positive 3 15 3 13.64
0.90 N.S
Negative 17 85 19 86.36

Rh factor

Positive 17 85 20 90.91
0.557 N.S
Negative 3 15 2 9.09

Data presented as Mean ±SD, (n) is number of patients and (%) is percentage.
Chi-square test for numerical values to compare between group 1 and group 2 where,
NS: Not significant (P>0.05).

- Response of H. pylori infected patients to triple therapy alone and in

combination with curcumin

Table (2) and figure (1) showed the percentage of H. pylori eradication of both study
groups 1 and 2 patients as follows:

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

In group 1 patients the mean percentage of H. pylori eradication was (60%) with standard
triple therapy, while the mean percentage of H. pylori eradication with triple therapy in
combination with curcumin in group 2 patients was (95.45%) after 6 weeks from the
intervention starting point. Statistically high significant difference in H. pylori eradication was
presented between patients of study groups 1 and 2 (P<0.01) after 6 weeks from the intervention
starting point and up ceiling for patients on triple therapy with adjuvant curcumin.

Response of H. pylori infected patients to triple therapy alone and in combination with
curcumin

Study groups Patients H. pylori eradication

N n %
Group 1 20 12 of 20 (60)
Group 2 22 21 of 22 (95.45)
P value 0.003**

Data founded as (n) is number of patients and (%) is percentage. Chi-square test used for
numerical values to comber between the results of group1 and group 2 where,
(
**)(P<0.01): Highly significant

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

H. pylori eradication
120

100
H.pylori eradication %

80

60

40

20

0
group 1 study groups group 2

Figure(1): Response of H. pylori infected patients to triple therapy alone and in

combination with curcumin.

- Effect of triple therapy alone and in combination with curcumin on H.

pylori eradication according to ABO blood groups phenotypes

Table (3) and figure (2) presented the percentage of H. pylori positive patients according to
ABO blood group phenotypes as follows:

After 6 weeks from the intervention starting point, group 1 peptic ulcer patients holding blood
group A presented with (66.67%), and O phenotypes presented with (57.14%) of H. pylori
eradication after standard H. pylori eradication therapy, while patients with blood group B
phenotypes presented with (80%) of H. pylori eradication but there was no eradication for patient
with blood group AB. On the other hand, with curcumin adjuvant therapy, the mean percentage
of H. pylori eradication in group2 peptic ulcer patients was (100%) for blood group A,AB,O and
(83.33)in patients with blood group B phenotype.

Statistically there was highly significant difference in mean percentage of H. pylori

eradication between both study groups 1 and 2 patients holding blood group AB phenotypes (
P<0.01) and significant difference for patients holding blood group O phenotypes( P<0.05) after
6 weeks from the intervention starting point. There was no significant difference in H. pylori

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

eradication for patients carrying blood group A and B phenotypes between both treatment
regimens(P> 0.05).

Table (3): Effect of triple therapy alone and in combination with curcumin on H. pylori
eradication according to ABO blood groups phenotypes

Study groups

Group 1 H. pylori Group2 P. value

ABO
eradication H. pylori
phenotypes
n (%) N (%) N (%) Eradication
N (%)

A 6 (30) 4/6 (66.67) 4 (18.18) 4/4 (100.0) 0.083 N.S

B 5 (25 ) 4/5 (80.00) 6 (27.27) 5/6 (83.33) 0.887 N.S

AB 2 (10) 0/2 0 3 (13.64) 3 /3 (100.0) 0.000**

O 7 (35) 4/7 (57.14) 9 (40.91) 9/9 (100.0) 0.022*

Total 20 (100.00) 12 (60.00) 22 (100.0) 21 (95.45) 0.003**

Data presented as(n) is number of patients and (%) is percentage.

Chi-square test used for numerical values to comber between the results of group1 and
group 2 where,
N.S: Not significant (P>0.05), (*)(P<0.05): Significant, (**)(P<0.01): Highly significant

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

Figure (2): Effect of triple therapy alone and in combination with curcumin on H. pylori
eradication according to ABO blood groups phenotypes

- Effect of triple therapy alone and in combination with curcumin on

body mass indices (BMIs) of H. pylori infected patients with different
ABO phenotypes.

As presented in table (4) and seen in figure (3), there was statistical non-significant
difference in level of mean BMI between the different blood groups(A,B,AB, and O) for both
groups 1 and 2 patients at the baseline level (P>0.05). After 6 weeks from the intervention
starting point there was statistical non- significant increase in level of mean BMI for study
groups 1 patients carrying blood group A , but for patients carrying blood group (B,AB and O)
there was non- significant decrease in mean BMI (P>0.05). .

Study group 2 showed statistically non- significant increase in level of mean BMI for patients
carrying blood group A and O, but non- significant decrease for patients carrying blood group B
and no change in mean BMI for patients with blood group AB (P>0.05). Again, there was no
significant difference among ABO phenotypes (A,B, AB, and O) for both groups 1 and 2 patients
after 6 weeks from the intervention starting point(P>0.05).

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

Table (4) Effect of triple therapy alone and in combination with curcumin on body mass
indices (BMIs) of H. pylori infected patients with different ABO phenotypes.

BMI(Kg/m2) of group 1 ABO phenotypes

A B AB O P-value
Pre treatment 28.92 23.32 26.70 27.42 0.921 N.S
Post treatment 29.20 23.29 26.40 27.39 0.911 N.S
P- value 0.931N.S 0.985 N.S 0.985 N.S 0.986 N.S
BMI(Kg/m2) of group 2 ABO phenotypes
A B AB O P-value
Pre treatment 25.95 25.50 26.03 27.67 0.991 N.S
Post treatment 26.37 24.77 26.03 28.21 0.973 N.S
P- value 0.868 N.S 0.735 N.S 1.00 N.S 0.850 N.S

Statistically, independent t-test is used to compere between pre- and post-treatment results
for different ABO blood groups where, N.S: Not significant.

30
29
28
27
BMI ( kg / m2 )

26
25 Pre-treatment
24
Post-treatment
23
22
21
20
A B O AB A B O AB
Group1 Group2

Figure (3): Effect of triple therapy alone and in combination with curcumin on body mass
indices (BMIs) of H. pylori infected patients with different ABO phenotypes.

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

Discussion

Infection of H. pylori is a worldwide problem in peptic ulcer disease patients with high
risk for morbidity and mortality[19]. The most effective therapeutic regimen was evaluated by
several studies to improving the H. pylori eradication rate [17-20].This study is another attempt
in this respect, though at a smaller scale, which might be (at least to best knowledge) the first
attempt to investigate whether addition of Curcumin to the standard triple therapy will increase
the eradication rate of H. pylori infection according to patients ABO blood group phenotypes.
The activity of curcumin alone in peptic ulcer disease was experimentally investigated
previously in vitro as possessing antioxidant and anti-inflammatory properties, and to attenuating
gastric hyper secretion (as a major pathology caused by H. pylori microorganism in gastric and
duodenal ulcer), along with its inhibitory effect for pepsin was found[14]. Moreover, other in
vivo and in vitro studies explored the inhibitory effect of curcumin against H. pylori growth,
consequently eradicate H. pylori infection [21]. In clinical trial, curcumin supplement alone is
still under investigation in which it is expected to play a potential role in suppressing H. pylori
growth [22].
In the present study, and in many other, patients with peptic ulcer disease caused by H.
pylori infection were mostly in a middle age of <50 years[23-25]. Female patients had the higher
rate of infection with H. pylori microorganism, similar finding was found among Iraqi
population in other studies[26], inversely, male gender were predominant to females in
others[27,28].
Positive family history was correlated positively with H. pylori infection in previous
studies. The H. pylori infections tend to distributed within families by close person-to-person
contact[29], Other data reported by Shokrzadeh, 2012 et al. showed that positive family history
of peptic ulcer disease was seen in about 24% of H. pylori positive patients[30].

The most common H. pylori eradication regimen was the proton pump inhibitor (PPI)-based
triple therapy (a PPI with two different anti-microbials)[31], which was studied on groups of
Iraqi patients with other regimen as well[20,32]. The triple therapy for H. pylori improve ulcer
healing, produce rapid relief for symptom, and decrease ulcer recurrence. However, failure of H.
pylori eradication contributed by different host and bacterial factors, especially factors affecting

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

the bioavailability and metabolism of proton pump inhibitor [33], low patient compliance,
particularly in elderly patients[34]. However, increasing antibiotic resistance - strains of H.
pylori especially for clarithromycin and metronidazole became the most contributing factor for
treatment failure[33,35].

In the present study, the eradication rate of H. pylori was increased from (60%) with
standard triple therapy alone up to (95.44%) after use of curcumin as adjuvant therapy. As
monotherapy, the effect of curcumin against H. pylori infection was previously studied and
reviewed by other researches[9,36], meanwhile Di Mario, 2007et al. showed that administration
of 30 mg of curcumin b.i.d for 7 days, 20 mg of pantoprazole b.i.d, 100 mg of bovine
lactoferrin b.i.d, and 600 mg of N-acetylcysteine b.i.d, cure only (12%) of dyspeptic patients
infected with H. pylori, while after 2 months there was a significant reduction in severity of
overall symptoms[37]. This study might be a new trend for improving the eradication rate of H.
pylori infection with curcumin adjuvant to the (PPI)-based triple therapy, which alone showed
(40%) eradication failure rate, while with adjuvant curcumin therapy the eradication failure rate
was(4.55%)

The relationship between ABO blood group phenotypes and the incidence of peptic ulcer
disease caused by H. pylori infection had been investigated previously worldwide[38,39] and in
Iraq[40,41].

In the present study, the percentage of H. pylori eradication for patients holding blood group
A,O, and AB was increased to (100% ) after the addition of curcumin to the standard H. pylori
eradication triple therapy. No matched studies were found that can interpret the exact role of
curcumin on the H. pylori eradication among different blood groups phenotypes patients.

There are specific phenotypic features related to PUD patients carrying ABO phenotypes,
PUD patients carrying blood type A phenotype are most likely to develop gastric cancer
seconda r y t o GU[41].Those patients are characterized by acid hypo secretion, and low serum-
pepsinogen level[42].On the other hand, PUD patients carrying blood group O are prone to have
persistent colonization of H. pylori[43] following the expression of Lewis antigens (Leb) in
gastric mucosa which act as a receptor for bacterial adhesion[44], expression of H-antigen on
the gastro duodenal cells, acting as a receptor for H. Pylori[44,45], the expression of blood group
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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

antigen b-binding adhesion (babA) on the outer membrane of H. pylori[46], and cagA-positive
virulent strain H. pylori colonize in both the corpus and antrum [47]. Moreover, patients with
blood group O phenotype stimulate a higher inflammatory responses to H. pylori with higher
levels of lymphocyte infiltration in the gastrointestinal mucosa[48], have low level of Von
Willebrand’s factor (VWF)[49], high frequency of secretor status[48], and high gastric
acidity[42] which reduces the efficacy of antibiotic therapy [50]. Accordingly, and all together,
may explain the higher susceptibility of patients holding blood group A, AB, and O, phenotype
for H. pylori eradication following curcumin adjuvant therapy.
globally; the distribution pattern for BMI changed within and between different populations
according to socioeconomic status [51]. The ABO phenotypes and BMI have been considered
as risk factors for certain diseases, some studies examined the effect of carrying a specific ABO
phenotype on body mass index[52-54]. One study from India showed a correlation between the
O blood group and obesity in children[55]. While other showed a prevalence of high body
weight in patients with B blood group[56]. In contrast other study showed no relation between
BMI and ABO phenotypes[57]. The beneficial effect of H. pylori eradication on BMI had been
studied previously [58,59] ,while other study was not able to showed any effect [60].
In the present study addition of curcumin as adjuvant therapy produced non significant increase
in BMI compared to triple therapy alone among different ABO blood groups patients. No
matched studies were found that can explain the exact role of curcumin on the BMI among
different blood groups phenotypes patients.
Increase in BMI after eradication of H. pylori may be due to improvement of some
postprandial symptoms such as early satiety [58]. Other study showed that after H. pylori
eradication there was a significant change in circulating meal- associated levels of ghrelin and
leptin with subsequent effect on BMI[61]. While other cohort study showed no association
between seropositivity of H. pylori with leptin level or BMI[60].

CONCLUSION

This study revealed that use of adjuvant curcumin with standard triple therapy produced
improvement in H. pylori eradication for all patients with different ABO phenotypes. Also, use

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 Kerbala Journal of Pharmaceutical Sciences. No. (15) 2018 (15) ‫ﻣﺟﻠﺔ ﻛﺭﺑﻼء ﻟﻠﻌﻠﻭﻡ ﺍﻟﺻﻳﺩﻻﻧﻳﺔ ﺍﻟﻌﺩﺩ‬

of curcumin with triple therapy produced non significant increase in BMI compared to triple
therapy alone among different ABO blood groups patients.

ACKNOWLEDGMENT
The authors would like to thank Al-Mustansiriyah University (www.uomustansiriyah.edu.iq),
Baghdad - Iraq for its support in the present work and special thanks to Baghdad Teaching
Hospital, Medical city for their help in providing the practical platform of this study.

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