Free Radical Activity and Plasma

The aim of this study is to evaluate the status of endogenous antioxidant defense system in H. pylori-infected endoscopically diagnosed chronic duodenal ulcer patients through the assessment of certain oxidative stress biomarkers. These biomarkers namely plasma malodialdehyde (MDA) and blood activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) are to be evaluated before and after the administration of the histamine H2 antagonist nizatidine alone or with either vitamin E (α-tocopherol) or thioctic acid (α-lipoic acid) or a combination of both. The same biomarkers were also assessed before and after administration of H. pylori eradication therapy. The effect of antioxidant and H.pylori eradication therapies on ulcer healing rates was also investigated. Moreover, the efficacy of H.pylori eradication by combined use of nizatidine with the macrolide antibiotic "clarithromycin" and amoxicillin was also evaluated in close association to ulcer healing. H.pylori-infected duodenal ulcer patients are subjected to massive oxidative stress as reflected by a significant decrease of erythrocytic GPx and SOD activities and elevation of plasma MDA levels. Treatment of H.pylori-infected duodenal ulcer patients with nizatidine alone failed to produce any significant change in any of the measured oxidative stress biomarkers. Treatment with nizatidine in combination with either vitamin E, thioctic acid or a combination of both resulted in a significant increase in erythrocytic GPx and SOD activities and a significant decrease in plasma MDA level. Some post-treatment values of certain oxidative stress biomarkers (e.g. MDA, GPx and SOD) were not significantly different from normal control values following oral treatment with H.pylori eradication therapy or nizatidine combinations with either vitamin E, thioctic acid or a combination of both. The use of triple H.pylori eradication therapy consisting of nizatidine (300mg once daily for 6-weeks), clarithromycin (500mg twice daily for 10 days) and amoxicillin (1000mg twice daily for 10 days) resulted in 100% eradication rate of the organism in H.pyloriinfected duodenal ulcer patients. Attenuation of oxidative stress in H.pylori-infected peptic ulcer patients either by combined nizatidine/antioxidant treatment or by H.pylori eradication therapy was associated with higher ulcer healing rates (on a percentage basis) as compared with patients treated with nizatidine alone. In patients receiving H.pylori eradication therapy, the ulcer healing rate was 100% compared to 60% in those treated with nizatidine alone and 86.67%, 73.34% and 93.34% in patients treated with nizatidine in combination with either vitamin E, thioctic acid or a combination of both respectively.