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New Approaches in Gastritis Treatment
Guillermo Marcial, Cecilia Rodríguez, Marta Medici and Graciela Font de Valdez
Centro de Referencia para Lactobacilos (CERELA-CONICET) Argentina 1. Introduction
Gastritis is an inflammation of the stomach lining, which is fairly common and could have different causes. Many kind of agents may lead the stomach into an inflamed statement; in first place, it could be due to non-steroidal anti-inßammatory drugs (NSAID) such as aspirin, ibuprofen, naproxen, etc. (Fig. 1), which are used in different treatments to calm down some specific illness, e.g. rheumatoid arthritis; in second place, inflamation could be due to abrasive compounds (alcohol, acids and others) or unbalanced diets where the stomach is damaged by its own gastric acid; in third place, long-term physical and/or mental stress that result in the production of excessive amounts of stomach acid; in last place, the infection caused by a well-known microorganism, Helicobacter (H) pylori. When stomach inflammation is not treated, mainly in the latter case, the illness could end in a gastric ulcer or in the worst case, in gastric cancer. The signs and symptoms of gastritis depend on how long the problem has existed. If it occurs suddenly is called acute gastritis. In acute phase, superficial inflammation of the stomach causes the classic nausea and pain or discomfort in the upper abdomen. If it develops gradually is called chronic gastritis, and the symptoms might vary from those of acute, with a dull pain in the upper abdomen and a feeling of fullness and loss of appetite after a few bites of food. However, in some cases, people with chronic gastritis could not feel any of these symptoms. Another type is the reactive or chemical gastritis, which is defined as a foveolar elongation, tortuosity, and hypercellularity of the gastric surface epithelium, together with edema, vasodilatation, congestion of gastric lamina propria, and a paucity of inflammatory cells. This type of gastritis has been thought to result from duodenogastric bile reflux or the use of NSAIDs (Voutilainen et. al., 2002). Clinicians differ on classification of the less common and specific forms of gastritis, particularly since there are so much overlap with H. pylori in development of chronic gastritis and its complications. Other types of gastritis that may be diagnosed include: a) Acute stress gastritis, the most serious form of gastritis which usually occurs in critical ill patients, such as those in intensive care, where stress erosions may develop suddenly as a result of severe trauma or stress to the stomach lining; b) Atrophic gastritis, resulting from chronic gastritis which is leading to atrophy, or decrease in size and wasting away of the gastric lining. Gastric atrophy is the final stage of chronic gastritis and may be a precursor of gastric cancer; c) Superficial gastritis is a term often used to describe the initial stages of chronic gastritis; d) Uncommon specific forms of gastritis include granulomatous, eosiniphilic and lymphocytic gastritis (Sipponen & Price, 2011).

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154

Gastritis and Gastric Cancer – New Insights in Gastroprotection, Diagnosis and Treatments

A recent advance in the histopathology of gastritis is the replacement of the traditional definition of gastric atrophy, “loss of glands”, with the new definition of gastric atrophy as the “loss of appropriate glands”. By this definition, intestinalized glands represent atrophy when the metaplastic change involves the entire length of the original glandular unit and is considered as metaplastic atrophy. The application of the new definition has resulted in a high level of agreement among gastrointestinal pathologists trained in different cultural contexts. As there is obvious evidence that the severity and the extent of gastric atrophy relate to different risk levels of gastric cancer, an international group of gastroenterologists and pathologists, Operative Link on Gastritis Assessment (OLGA), has developed a system of histologically reporting gastritis by combining the semi-quantitative scoring scale of the updated Sydney system (Stolte & Meining, 2001) with the new definition of gastric atrophy. This system expresses the extent of gastric atrophy in terms of gastritis staging (Quach et. al., 2011). Nowadays, one of the most important cases of gastritis is the infection by H. pylori strains. This affection was the attention focus that led to many researchers in the last years to study different branches of the infection process (Chenoll et. al.; 2011; Cui et. al., 2010; Ko et. al., 2010; Wittschier et. al., 2009; Wolle & Malfertheiner, 2007). However, equal important is the gastritis associated to the consumption of NSAIDs since these drugs are widely used to treat some pains. The chronic use of NSAIDs is a common cause of gastroduodenal erosions and peptic ulcers resulting, in many cases, in fatal haemorrhage. Aspirin, a famous NSAID, is thought to cause gastric damage by both, topical irritant effects on the gastric epithelium and systemic effects related to suppression of mucosal prostaglandin synthesis (Fig. 1). Inhibition of prostaglandin synthesis reduces mucosal defenses, including mucus and bicarbonate secretion, blood ßow, epithelial cell turnover and repair, and mucosal immunocyte function. NSAIDs can also interfere with the healing of preexisting lesions and cause a fast drop in pH within the mucus cap (Shiotani et. al., 2008). In clinical practice, a prostaglandin E1 derivative, misoprostol, and anti-acids, including proton pump inhibitors (PPIs) are routinely used for the treatment and prevention of NSAID enteropathy (Peura, 2004). The authors previously reported the usefulness of PPIs for healing the small intestinal mucosal injury in experimental animal models treated with NSAID; however, there are no clinical data on the usefulness of PPIs in such injuries. Some studies indicated the efficacy of misoprostol on NSAID-induced intestinal injuries (Kuroda et. al., 2006) whereas others reported no effectiveness (Davies et. al., 1993). Among the most conventional drugs employed, PPIs such as omeprazole (OPZ) and its derivates are the most common although most of these drugs produce undesirable side effects and drug interactions (Pali-Schöll et. al., 2010, 2011). OPZ is available over-thecounter and in inexpensive generic formulations. It is promoted as a therapy for a range of disease states, from mild heartburn to aggressive H. pylori gastritis (40 mg can suppress over 80% of gastric acid secretion) being also one component of the triple-agent therapy (clarithromycin, amoxicillin, omeprazole) that is commonly used to eradicate H. pylori infection (Logan et. al., 1995). However, it is increasingly well-recognized that OPZ may also contribute to gastric gland toxicity, effect demonstrated by Kohler et. al. (2010) in rabbit gastric gland at physiologically relevant doses. Data suggest that thiol oxidation negatively affects intracellular proteins, which are susceptible to this chemical reaction. Authors also evinced that OPZ toxicity can be reversed with Vitamin C, thus providing an explanation for the previously observed beneÞts of Vitamin C co-administrated with OPZ in H. pylori gastritis (Kohler et. al., 2010).

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al.Blood flowing . Anti-ulcer drugs are useful co-medications to protect the gastric mucosa from damage due to steroidal and non-steroidal drugs. This is especially relevant during long-term pain and antiinflammatory therapies. Deleterious effects of NSAIDs after administration for long periods.0 for treating bleeding www. e. e. or acid neutralizers like bismuth compounds (co-prescribed to protect the gastric mucosa).com . The intake of NSAIDs for long periods blocks the PGE2 generating unbalance in the process and situations of cytotoxicity.Gastric pain . These conditions lead gastric mucosa to be unhealthy and to come into gastritis process. histamine type-2 receptor antagonist. in management of rheumatoid arthritis or inflammatory bowel disease.Dyspepsia .5 (Julapalli & Graham.Congestion . The therapy goal is to reach gastric pH levels above 4.intechopen. sucralfate. 2005) also for children (Tofil et.Injury to the mucosa .Hemorrhage -Pyrosis .g. Inhibition or neutralization of gastric acid with so-called anti-ulcer drugs is necessary to treat gastritis and peptic ulcers. drugs such as PPIs. GASTRIC ULCERS Fig..releasing H+ secretion Blood flowing .PMN GASTRITIS.New Approaches in Gastritis Treatment 155 Membrane Phospholipids Phospholipase A2 NSAIDs corticosteroids NSAIDs Araquidonic acid COX-2 (Inducible) COX COX-1 (Constitutive) Direct action Adverse effects PGE2 Mucus secretion Cell regeneration HC03. 1.Irregularity . Normal levels of PGE2 helps gastric mucosa in keeping its normal characteristics. 2008) or even above 6.g.

The novel therapies include natural compounds or their derivates co-administered whith conventional drugs.. Formica & Regelson. seed. De la Cruz et. fruit or mixtures). Rehecho et. Most studies addressed the gastroprotector effect of different plants extracts in experimental models. urinary/genital. although the main usage is against gastrointestinal and respiratory problems (Al-Qura´n. 2003. Examples of some medicine plants against gastric disorders are presented in Table 1. These biological and natural products include beneficial microorganisms and plants. 2007. pylori. The success rate of conventional eradication of triple therapy is ca.. mainly due to H. 2007. administration and mainly their properties.... Castillo-Juarez et. rhizome. and/or anti-acid. al. internal and external inflammatory process. pylori antibiotic resistance (Wolle & Malfertheiner. al. they could also display anti-H. Asteraceae and Lamiaceae families are mainly used as gastroprotector. Lengsfeld et. ulcers and even advanced processes like cancer model (De la Cruz et. analgesic and anti-inflammatory. al. research studies were focused on the gastroprotective. al. stem. Nergard et. The number of plants species around the world is infinite and medicinal plants are used to treat different kind of pathologies like infection. that could interact with the mucosal barrier cells by changing the cell metabolism and modifying the cellular regulation. Avoidance of acid is needed to stop autodigestive processes and support mucosal healing in the extreme environment of the gastric lumen. 2007). etc. Nowadays. 2000. The tea is the extract obtained after maintaining raw plant materials in contact with hot water during certain time (the methodology could change if it is infusion or decoction. parasitosis. 2004).. leaf. Diagnosis and Treatments peptic ulcers (Pali-Schöll et. al. 2010). In addition to the cost of the treatment. 2010). dermatological.156 Gastritis and Gastric Cancer – New Insights in Gastroprotection. The knowledge of plant properties was acquired by ancient civilization that passed down from generation to generation until today and it is known as “popular medicine or traditional medicine” (Al-Qura´n. 2. bark.com . pylori as the main ethiological agent of chronic gastritis and peptic ulcer disease. studies of natural products in gastritis therapy have become the main research area around the world. 2009). The surveys of popular medicine are useful to understanding the application of different plant species.intechopen. 80% but it is constantly decreasing worldwide. Beverages are known in different cultures as “tea”. e. The principal way of administration is like beverages.. this kind of beverages could be effective against gastric mucosal inflammation (active chronic gastritis. hemorrhoids. gastritis (mucosal inflammation and mucosal infectious model). al. Before the recognition of H. 2009. www. pylori activity (Coşkun et. thus having antimicrobial activity besides anti-inflammatory effects.. Neves et. al. 1995.. 2004).. In some cases. infusion or decoction of different parts of the plants (root. diabetic problems. where decoction is an aggressive process of extraction). which might cause side effects. but at the same time they are also used against other diseases as wound healing. In this extract it is possible to find different compounds like polyphenols.g. erosive or not) and also against H. blood pressure. flavonoids (glycosilated or not) and polysaccharides among others. al... al. Kahraman et. the way of usage. flowers. 2009. 2004. al. Phytotherapy on gastric diseases Plant derivates had been employed by population to prevent different kind of diseases for centuries. and/or anti-inßammatory effects of traditional medicinal plants and their mode of action (Borrelli & Izzo. this kind of therapy involves taking too many drugs. 2009).

. Brassica nigra Seeds (L..al. Decoction Stomachache Vitalini et.Koch Maytenus Espinheir Leaves Infusion ilicifolia Mart.. and stomachache.. al. parts. stomach disorders Stomachache Jordan Al-Qura’n et. parts Croton cajucara Sacaca (P) Leaves Infusion Benth barks Southern Africa Perú (NorYauyos) Wittschier et. Asia and South America Italy (Valvestino ) Perú (Canta. wound healing Perú (Canta. 2009 Brazil Hiruma-Lima et. Ageratum conyzoides L.. Baggio et. al. 2007 Neves et. Brazil. 2009 Compositae Antiulcerogenic. 2007 Shirwaikar et. al. cancer treatment. Achillea Mifoil (E) Aerial Infusion tomentosa L. al. al. Argentina Portugal (Trás-osMontes) Pertino et.New Approaches in Gastritis Treatment 157 MEDICINAL PLANTS USED IN GASTRIC DISEASES AROUND THE WORLD Mode Plant Common Part Traditional Country/ Family of References species name used uses region using Acanthaceae Dicliptera peruviana (Lam. al. a santa (P) Decoction Gastrointestinal Mali disorders. 2010 Giday et. Rehecho et... e rova (G) zome Decoction Stomach acidity Geraniaceae Geranium Erva de S. Braun. Hatsuko Contraceptive.J. al.) W. gastrointestinal disorders Euphorbiacea Jatropha isabelli Yagua RhiInfusion/ Gastroprotective Muell.. parts intestinal pain Roots Brassicaceae Celastraceae Brassica carinata A. Serrano (S) Vernonia kotschyana Sch. 2004 Leaves Decoction Stomachache. 2007 Elmann et. al. 2000 Paraguay. 2010. roseum (S) decoction carminative. al.. abortifacient.com . gastritis . (I) Tagetes elliptica Chinche Smith (S) Tagetes filifolia Anis Lag. al. al. 2009 De la Cruz et.intechopen. Lima) Perú (Ancash) De la Cruz et. 2010 www. roots Bico de uterus pinga inßammation amor (P) Pelargonium Umckaloa Roots Antimicrobial sidoides DC bo (A) effects Pelargonium Geranio Leaves Infusion/ Digestive.. 1998 Nergard et. al. Lima) West Africa. digestive Aerial Decoction Stomachache. 2003 Asteraceae Carlina acaulis Caroelina Roots L. (Andrews) gastritis.) Juss. Roberto. (Showbak) al. al. 2010 Argentina... intestinal pain. Aerial molle L.D. ... al. cold macerate and gastroduodenal ulcers Koza (ET) Leaves Gastritis Ethiopia (Sheko) Stomachache Ethiopia (Sheko) Giday et. gastric Decoction ulcers. Paraguay 2007 emenagogue.Leaves Infusion Stomachache chuncho (Q) Leaves Infusion/ Purgative. Chuncho.. 2007 Hammond et.

Aerial redondinh parts a (P) Portugal (Trás-osMontes) Melissa officinalis L. hemorrhagias of the gastrointestinal tube. SchmidtLebuhn. parts.. to treat diarrhea. 2008.. 2009. Ratanya Roots. Asia Minor and Middle East Jordan Abdominal (Showbak). al. digestion and bile stimulation. Lima) Gastric ulcers. al... www.Aiton amigdalitis. 2009. renal problems. others Stomachache Krameriaceae Krameria lappacea (dombey) Burdet et B. Simpson Glechoma Lamiaceae hederacea L.. Infusion stems Leaves Oil Fabaceae Glycyrrhiza glabra L. al. emolient . (Trás-os2009. 2010 Perú (NorYauyos) Minthostachys Muña (S) mollis (Kunth.. fever. al. others Digestive. al. et.intechopen. Menta (S) Infusion Portugal Neves et.) Griseb. gastritis and acidity. 2010. al. others Intestinal gases and pain. Liquorice Roots (E) Syrup Malvaceae Althaea rosea (L. 1998. stomachache and gastritis. gastric Mediterran ulcer. west stomachache and east Africa Diuretic.. Asia . Wittschier et. al. 2002 Al-Qura’n et. 2007 De la Cruz et. Hortelão. al.diuretic. 2009 Malvela. stomach pain.T...158 Gastritis and Gastric Cancer – New Insights in Gastroprotection. expectorant ean region. al. or Ratiñay stems (Q) Perú (Ancash) Hammond et. al.. 2009 Al-Qura’n et.) Cav. rheuma. leaves Pimenta (P). Aerial Rose mallow (E).. De la Cruz et. inflammation. 2007 Neves et. al. others. analgesic. Diagnosis and Treatments MEDICINAL PLANTS USED IN GASTRIC DISEASES AROUND THE WORLD Mode Plant Common Part Traditional Country/ Family of References species name used uses region using W. Ocimun suave Willd Mala mujer (S) Olomora (A) Leaves. treatment of stomach cancer Cough. De la Cruz et. dyspepsia and biliar disorders. anti. al. Rehecho Montes). diarrhoea. others Decoction Diarrhea. Leaves Infusion Perú (NorYauyos) Marrubium vulgare L. colitis and Portugal Rehecho et.. carminative. Green Piperita. Cidreira (P) Aerial parts - Portugal (Trás-osMontes) Neves et.com . Neves et. Alteia (P) roots Infusion Perú (Canta. gastritis and colics. 2009 Lamiaceae Mentha piperita L. al... inflammation. al. cough.Tropical cathartic. 2007 Tan et. Digestive and antißatulence to relieve gastritis.

Northeast HydroBrazil alcoholic stomachache tincture Central Infusion/ Dyspepsia. 2004 Al-Qura’n et. Decoction Antidysenteric. mimosa anti-spasmodic (P) Pomegran Fruits Fresh Ulcer. al. Sarcopetertum spinosum (L. Calceolaria lobata Cav. Argentina indigestion. gastric inflammation Barba-de. gastric irritation Poppy(E) Leaves.New Approaches in Gastritis Treatment 159 MEDICINAL PLANTS USED IN GASTRIC DISEASES AROUND THE WORLD Mode Plant Common Part Traditional Country/ Family of References species name used uses region using gastritis.. Polígala paniculata Linneau Africa. and Decoction diuretic. Lima) Decoction Narcotic. 1998 Polygalaceae Portugal (Trás-osMontes) Brazilian Atlantic coast Neves et. gastric diseases Zapatito Leaves. 2009 Rocha Lapa et. 2007 Gorzalczany et.) Hieron.com . South Africa Jordan (Showbak) Ajaikumar et. Infusion Stomachache or globo. dental growth and development. mycoses.Aerial Gastrprotector ...intechopen. al. parts Lippia Incayuyo Aerial integrifolia (S) parts (Gris. 2009.. Jordan stomachache (Showbak) Wounds.. tonic fever. (Q) parts Juice juice is swallowed to treat gastric ulcers Grama (P) Dried Diuretic. al. al. hepatic ate (E) fruits damage.) Moench. IndoChina. burnet (E) fruits antidiabetic. al. bonchitis. al. al. Infusion Stomachache globo (S) flowers (Trás-osMontes) 2009 Abelmoschus esculentus (L... Soaking Renal calculi. (E) parts Lippia siodides Aerial Cham. al. Lima) Perú (Canta. al. Perú (Canta. Hammond et al. 2008 Hyoscyamus Handbane Aerial aureus L.. others Thorny Roots. hypnotic.. stems antispasmodic Congona Aerial Crushed/ Wounds healing. Rosaceae Solanaceae Verbenaceae Europe. pleura infection... Scrophulariac Calceolaria bicolor Ruiz & eae Pav. Asia and America Jordan (Showbak) Perú (Ancash) Lengsfeld et.vasso stomach pain.) Spach. 2007 Al-Qura’n et. joão. 2009. antibranca or inflammatory. De la Cruz et.flowers globo (S) GloboLeaves. urinha diarrhea.. sãoparts asthma. others Okra Fruits Fresh Cholesterol fruits reduction hypoglycemic. roots depurative. heart and gastric diseases. 2007 Punicaceae Punica granatum L. cough Northwest treatment. Papaveraceae Papaver rhoeas L. 2005 Al-Qura’n et. 2007 De la Cruz et. al. Peperomia Piperaceae galioides HBK var gladioides Poaceae Cynodon dactylon L. stomachache www. 2009 Barros Monteiro et. al.

g. mucus wall structure. In normal mammalian stomach. and help us to understand the way of action of natural compounds or complex extract of medicinal plants. The importance of such effects is to assure the gastric mucosal integrity by a dynamic balance and homeostasis between epithelial cell renewal and cellular apoptosis. Infusion Pautucano or barks pau-doce (P) Fruits Heel kalan. 2007. 2003). asthma. al. are the major compounds associated to human health and beneficial effects on gastritis. Results obtained in the framemark of pre-clinical studies may be extrapolated to human cases (Elseweidy et. (E) English.com . rabbit. 2009 Zingiberaceae Amomum subulatum Roxb.. or prostaglandin (PG). (P) Portuguese. Perú. anti-inflammatory. al.. an indigenous language from Bolivia. ibuprofen and more). fruits (strawbery. pylori). They have been reported to exert multiple biological effects. gastric mucosal cells have a rapid rate of turnover. 2007.. beer.). N. ulcer and cancer. treatment of gastric trouble with phenolic compounds is not always beneficial to gastritis condition. (S) Spanish.. etc. acetic acid. immune mucosal response. 2007). Flavonoids are phenolic compounds widely distributed in a wide variety of edible plants including leafy vegetables. al. digestive. 2008.. 2002). anti-ischemic. pulmonary congestion India Stomacheache.. antihistaminic. a native language from Paraguay. al. myeloperoxidase (MPO) and nitric oxide (NO) regulation. histamine release from mast cell. However.. pig. stress (hypothermia). among others) where mucosal damage was induced by either chemical compounds (aspirin. On one hand. Wittschier et. scavenging oxygen-derived free radicals and even to gastric mucus stimulation (Rocha Lapa et.160 Gastritis and Gastric Cancer – New Insights in Gastroprotection. Bari ilaichi (I) Infusion South Stomach America inflammation. The phenolic compounds. 2001 Table 1. Diagnosis and Treatments MEDICINAL PLANTS USED IN GASTRIC DISEASES AROUND THE WORLD Mode Plant Common Part Traditional Country/ Family of References species name used uses region using Vochyslaceae Vochysla tucanorum Leaves. being entirely replaced within 3–5 days as the result of rapid proliferation of progenitor cells at the isthmus and rapid cell death at the gastric surface (Park et. Medicinal plants used for treatment gastric disorders according to native population of different areas around the world. al. etc. ethanol. and (G) Guaraní. antiemetic.1 Effects of phenolic compounds of medicinal plants on gastritis Gastritis troubles led to researchers to study the gastric mucosa in different animal model (rat. including antiviral.) and beverages (tea. (I) Italian. pylorus ligation or by microbiological agents (H. south-western of Brazil and north-eastern of Argentina.. These in vivo experimental assays are useful to resemble gastric diseases as gastritis or ulcers. reduction in histamine secretion. Tan et. The names of the species are given according to the regional language: (Q) quechua. HCl.intechopen. mouse. carminative Camargo Gomes et al. al. Jafri et al. al. antithrombotic. Hatsuko Baggio et. H+/K+ pumping block. 2.. antioxidant and freeradical scavenging abilities (Kahraman et. 2004). widely distributed in plants. red wine. The gastroprotective effect seems to be related to increase in endogenous PG. e. These compounds acts at different levels. the main effect is associated to anti-inflammatory response www. apple.. (ET) Ethiopian. O. north-western of Argentina and Chile.

increasing the superoxide dismutase activity which may play a role on gastric inflammation (Coskun et. fruits and beverages as tea. and stable radical) scavenging activity and NO generation in a concentration dependent manner.5. being as active as lansoprazole at 20 mg/kg. al.. but the mode of action remains to be elucidated (Schmeda-Hirschmann et. displaying greater gastroprotector effect (at dose levels of 500 and 750 mg/kg) than conventional drugs as misoprostol and famotidine. 2007). 2001). al. as well as modulation of the blood ßow (Atay et. al. The arabinogalactan fraction of this plant proved to be more effective than the ßavonoidrich fraction (Hatsuko Baggio et. as cited in Serrano et.7.com . 2003). 2002). Kahraman et.. similar results were obtained with OPZ. PG is responsible for the integrity of gastric mucosa through activation of a cascade of mechanisms that include inhibition of gastric acid secretion. Solidagenone and its derivative solidagen-6 -ol on the HCl/ethanol-induced gastric lesions in mice was assessed at 100 mg/kg.7-dihydroxy-8-methoxyßavone) which displayed similar effects of rebamipide (a well-known drug prescribed clinically for the treatment of gastritis and gastric ulcer) in the prevention of alcohol stomach injury (Park et.. 1999). al... etc. al. As an example. 2003. 2001). al.2diphenyl-1-picrylhydrazyl. Besides phenolic compounds. (Verbenaceae) caused inhibition of gastric lesions but did not stimulate mucus production. on the other hand. A novel natural product isolated from the Scutellaria baicalensis Georgi (Lamiaceae) roots (traditionally used against inßammation related diseases) is Wogonin (5. beer. The target of these compounds would be the araquidonic acid metabolism including suppression of 5lipooxigenase (LOX) and induction of ciclooxigenase-2 (COX-2). al. It is known for its vasoactive properties but it also prevented gastric mucosal ulcers induced in rats by the administration of ethanol. al.New Approaches in Gastritis Treatment 161 due to PG and NO inhibition. mucus and acid secretion (Uchida et. Different medicinal plants gave good results in gastric trouble treatments. (Celastraceae) named in Brazil as “espinheira santa”. 2007).. al. its antioxidant property may reduce the lipid peroxidation and protein carbonyl compounds. ilicifolia ßavonoid-rich fraction seems to be related to inhibition of gastric acid secretion (cyclooxygenase-prostaglandin system) rather than to glutathione and mucus regulation. Besides.intechopen.4’-pentahydroxyflavone) and catechins (belonging to the flavan-3-ols group) were identified in Maytenus ilicifolia Mart. Solidagenone is a labdane diterpene synthesized in rhizomes of Solidago chilensis Meyen (Asteraceae). 2004. terpenes from essential oil (EO) were also tested with outstanding results. Consequently. The flavonoid prevented the increase of MPO activity (associated to this experimental model) thus protecting gastric mucosa from the deleterious effects of activated neutrophil infiltration (Kahraman et. stimulation of mucus-bicarbonate secretion and apoptosis. it was used to treat symptomatologies related to inflammation.3’. thus displaying strong antiinßammatory activity on alcohol-related gastric disease (Cellotti & Laufer. 2004). both in vivo and in vitro models. Oral pretreatment of mice with EO from Lippia sidoides Cham. Flavonoids including quercetin (3. effects that were related to the anti-inflammatory and antioxidant activity of phenolic compounds. Quercetin is a common flavonoid distributed in a broad variety of vegetables.. The effective gastric protection of M. which are used in gastritis treatment (Shirwaikar et. the gastroprotective mechanism induced by the Lippia sidoides EO would not be related with cytoprotection (Barros Monteiro et. al. red wine... al.. 2003). The EO of Croton www. 2000) while NO is also involved in regulation of gastric motility. (Asteraceae) exhibited DPPH (2. these compounds are related to antiulcerogenic activity and/or inhibition of gastric acid secretion.. the ethanol extract of Ageratum conyzoides L.

which are responsible for interaction with mucosal glycoproteins and epithelial mucins. al. Nigela sativa (El-Abhar et.. may interact with the bacterial adhesins before adhesin-mucin adhesion avoiding the infection process. 2004).2 Effectiveness of plants glycoside derivate compounds on H. it seems that a frequent consumption could have a preventive effect in controlling the H. pylori population on infected people. Certain compounds. e. and TNF-α production.com . Kusters et.. 2. 2007.162 Gastritis and Gastric Cancer – New Insights in Gastroprotection. IL-1a. al. Ocimum basiliscum. This effect could be associated to some mechanisms: Reduction of iNOS expression or scavenging of NO molecule. 2008). about 77% of the assayed plants are active. Thus.g. Persea americana. over-expression of adhesion molecules. the lipid-peroxidation (expressed in terms of malondialdehyde and NO) decreased and pepsinogen secretion is stimulated. a constituent present in many essential oils and its derivatives 1-hydroxy-1-(4-methoxyphenyl)-propane and 1-hydroxy-1-(4methoxyphenyl)-2-m-chlorobenzoyl-propane seemed to have gastroprotector effect against ethanol-induced gastric lesions without modifying the mucus secretion (Freire et. al. Studies on the complex nature of these adhesins are reported by Evans & Evans. it failed to stimulate pepsinogen release from chief cells (Elseweidy et. al. the gastric mucus layer but nowadays research is focused on a new property of some natural compounds. pylori is based on bacterial adhesins located on its outer cell wall. Since some of these medicinal plants are used as condiments or food ingredients (e. 2006.intechopen. 2001). as cited in Warren and Marhall.g. having from moderate to strong antibacterial activity against H. 2005). pylori infection (Atherton. (2009). On the other hand. al.. (2009) studied the anti-H.. On the other hand. pylori activity of 53 plants used in Mexican traditional medicine for gastrointestinal disorders. so its therapeutic effect could be related to its antioxidant property. It has been suggested that the best way to prevent H. al. OPZ is an effective inhibitor of leukocyte inÞltration. pylori adhesion. 2000) also showed protective activities on gastric mucosa. authors compare the OPZ with natural compounds as curcuminoids. Zingiberaceae) and when are administered in rats with induced gastritis the serum NO level tend to decrease compared to control group (without treatment). pylori infections is to eliminate the pathogen from its most common habitat. On the other hand. pylori infection Phenolic compounds as flavonoids and their derivates have also antimicrobial effects as it was demonstrated in cases of H.e. pylori. Diagnosis and Treatments sonderianus (Muell.. Teloxys graveolens). Adhesion to epithelial cells has been recognized as an essential step of the infectious process for virtually all bacterial pathogens and therefore many efforts are aimed to develop anti- www. The green tea has confirmed its bactericidal and bacteriostatic effects in vitro assays while in vivo studies demonstrated that its consumption when is taken before infection prevents gastric mucosal inßammation. may inhibit the H. polysaccharides. 2003) and also when it is used together with sucralfate in Mongolian gerbils (Takabayashi et. Although curcuminoids signiÞcantly decreased serum gastrin level. 2002) and Croton cajucara (Hiruma-Lima et. On the whole.. The free radicals scavenging properties of curcuminoids and maintaining cellular glutathione (GSH) stores in glandular stomach are factors acting to inhibit lipid peroxidation. Wittschier et. Lippia berlandieri. al. the anti-H. 1983). and Wittschier et. Castillo-Juarez et. Arg). Anethole. Amomum sublatum (Jafri et.. curcuminoids are isolated from dried roots of turmeric (Curcuma longa. al. i. pylori urease (Matsubara et. When rats received OPZ. al. in this way the infection is established. and when is taken after infection diminishes the magnitude of gastritis. al.. catechins the main component of green tea.. (2000).. The adhesive process of H.. al. (2006).

LABs have limited biosynthetic abilities. www.com . 2007). which is used to produce cheese (species of Lactococcus) and yoghurts (species of Streptococcus and Lactobacillus). Some reports suggested that certain species of exogenous lactobacilli have inhibitory effects on gastric infection (Cui et. pylori (Wittschier et. LABs have a long and safe association with humans and their food (Wells & Mercenier. pylori to human gastric mucus and to human erythrocytes by cranberry juice (Burger et. Authors consider this anti-adhesive effect an advantage to prevent re-infection by H. it would seem appropriate to target such therapy against H. 2000. al. gastrointestinal tract and vagina of vertebrates. Dietary LAB refers to those species and strains that are used in food. contain a raw polysaccharide fraction mainly composed of arabinose.g. pylori infection. Lactobacillus (L. systemic cytokine production (Borchers et. plant surfaces and the oral cavity. including milk. 2009). al. al. galactose. purines. usually. pylori avoiding its adhesion to mucus (Wittschier et.) reuteri ATCC 55730 displayed ability to colonize the gastrointestinal tract and at the same time. LABs occupy a range of niches. Another example is the root extracts of Pelargonium sidoides DC (Geraniaceae) a medicinal specie used to treat acute respiratory infections. 2008).. Leuconostoc. pyrimidines and. The roots of Glycyrrhzia glabra L. which contains a polysaccharide fraction. 2009). al.. dietary inhibitors might be the solution for certain infections. However. Penner et.. 2010. which interacts with the outer-membrane surface adhesins of H.. 2005) providing beneficial effects to the host by modulating immune functions. gastrointestinal infections (Lebeer et. e. 2000).. al. with anti-adhesive activity against H. and require pre-formed amino acids. 1997). preventing various gastrointestinal disorders such as gastric ulcers and inflammation related to H. Consumed for centuries. Pediococcus and Streptococcus. As an alternative approach. Ryan et. a sugar as a carbon and energy source. The term LAB is a group of organisms that are defined by their ability to produce a common end product. pylori toward its association with the mucus before the pathogen adheres to the underlying epithelial cells and causes disease. al.g. glucose and glucuronic acid.. 2009). 2004.g. These beneficial effects lead us to conclude that natural inhibitors of bacterial growth and inßammation may offer alternatives to antibiotic therapy for bacterial eradication and may be used as supplements to conventional eradication therapy in populations at high risk for gastric cancer (Stoicov et.New Approaches in Gastritis Treatment 163 adhesion therapy. pylori after antibiotic eradication therapy. Different LAB species were tested in gastritis models mainly in treatment of H. EPs 7630. the inhibition of sialic acid-specific adhesion of H. Sialyllactose (NeuAc[K2-3]Gal[L1-4]Glc). e. 2010) or antibiotic-associated diarrhea (Chen et. Since ancient times. al. B vitamins. al. dietary LABs have been used to ferment a range of raw materials such as milk. Lactic acid bacteria in gastritis Lactic acid bacteria (LAB) are a group of Gram-positive. Probiotic foods containing LAB have been proposed as a natural alternative to improve the general health status.. al. al. pylori lectins as anti-adhesion therapeutic agents is still a problem to be solved. lactic acid. Accordingly. as cited in Glaser..and feed-fermentation processes. non-sporulating bacteria that include species of Lactobacillus. Gill & Guarner. 2009. pylori. the bulk production of oligosaccharides specific for the H. an inhibitor of the sialic acidspecifc adhesin of H. 2008).. 3. al. from the fermentation of sugar.intechopen. pylori infection. significantly reduced the load of the bacteria in monkeys (Burger et. to generate an inmune response when it was administered to human volunteers.. e...

. Bifidobacterium longum HY8001 and Streptococcus thermophilus B1. Cui et. Wang et. 2011). al. 2004).intechopen. gasseri OLL2716. Uchida & Kurakazu. www. they were treated according to the triple therapy. B. pylori-associated neutrophilic and lymphocytic inÞltration in animal model by reducing proinßammatory chemokine levels in the gastric mucosa during the early stages of infection (Sgouras et. bifidum BF-1 is able to suppress IL-8 induction by H. al. pylori infection for many reasons: LABs are able to resist acid and bile. al. According to these results it was suggested that stimulation of T-helper cells in human ileum could be a central mechanism of symbiosis for improving the health of the host gut (Valeur et. Mozzi et. al. pylori morphology and thereby inhibiting its growth. 2003. al. 2001) or ornithine decarboxylase activity (Linsalata et.. 2004) suggested that probiotics are an attractive option for counteracting the effects caused by H. pylori growth in in vitro assays. could alleviate the gastric inflammation in H. Gotteland & Cruchet. 2004). paracasei subsp. 2011)... These results would indicate that specific lactobacilli strains may colonize the gastric mucosa. (2010) demonstrated that L. 2004). 2008).. The administration of probiotic lactobacilli as L. al. reuteri was detected by ßuorescence in situ hybridization (FISH) in stomach and duodenum in some volunteers. al.. 2001). L.g.. (2010) evinced that L. al.. al. 2009. 1999. Sgouras et. fermenti (CCTCC M 206110) and L. Park et. Likely. As a conclusion. L. 2004). Liu et. pylori-infected patients were administered with yogurt (Will yogurt) containing L. al. johnsonii La1 displayed a pronounced anti-inflammatory effect on H. casei (M. al. pylori eradication rate.J. casei ATCC 393loaded chitosan microspheres inhibited H. 2005. Mater et. al. effects that persisted for several weeks after cessation of the treatment. at the same time.. Other LAB strains were also effective against H.. al. Results from in vitro and in vivo models (BALB/c mice) indicated that the strain partially relieves damage of gastric tissues caused by the pathogen and also decreases the H. pylori-infected BALB/c mice after oral administration. bifidum CECT 7366 is also a promising microorganism against H.. casei GG. 2007. acidophilus LC. al. casei HY2743.com . pylori pathogenicity ratio (Chenoll et al. Shirasawa et.. al. Diagnosis and Treatments After administration.. al. which may be related to their capacity to survive and develop in acidic environments (Cats et. al. pylori eradication was also evaluated (Kim et. The effect of LAB on acute gastric lesions induced by chemical agents in experimental models was also reported. 2010. acidophilus R0052 and L.. In vitro studies showed that certain LAB strains and their cell-free cultures are able to inhibit or kill H. 2009. 2004) also decreased in patients treated with probiotics. The inclusion of probiotics in a conventional therapy (triple therapy: antibiotics and PPI) for H... L. acidophilus HY2177. The markers for gastric inßammation such as prostaglandin I/II ratio (Sakamoto et. acidophilus and L.. to transiently remain under the harsh stomach conditions. Recently. pylori infection. pylori (Michetti et.. and to competitively exclude pathogenic bacteria. e. al. rhamnosus R0011 (Johnson-Henry et. pylori in gastritis cases..164 Gastritis and Gastric Cancer – New Insights in Gastroprotection. L. paracasei NTU 101 and L. Likely. Similar results were obtained with a commercial product (Lacidofil®) containing L. al. Authors (Johnson-Henry et. (2010) evinced that the probiotic strain B.. pylori through inhibition of the genes related to the NF-κB signaling pathways. Similar results had been reported using fermented milks with L. plantarum NTU 102 to rats inhibits the gastric mucosa injury in HCl/ethanol-induced ulcer and pyloric ligation models (Lam et. al. H. isolated from gastric biopsy materials of patients. the addition of yogurt did not reduce the side-effects of the therapy but increased the H. Valeur et. Cui et. al. 2004. al. 2003. The probiotic mixture exhibits bactericidal activity in a dose-dependent manner by altering normal H. Ko et. 2005). L. 2005) as well as to reduce urease activity in the human gastric epithelial cells (AGS) by exclusion effect (Lin et.

(2006) suggested that the biopolymers are involved in the mechanism of competitive exclusion of probiotics through adherence to the mucus and Nagaoka et.g. al. Ruas-Madiedo et. rhamnosus. paracasei. thermophilus CRL 1190 on superficial chronic gastritis in BALB/c mice as preventive and therapeutic treatment. they have effect on the mucosal immune system. al. al. 2006. L. S. al. 1991. Korakli et. Ruas-Madiedo et. al. a high EPS (1200 kDa) composed of D-glucose. and could make the mucus layer stronger. 1996). lactobacilli and streptococci strains. 2002). Salazar et. L. which may be constituted by 3 to 8 different monosaccharides (de Vuyst et. 2001. D-galactose and L-rhamnose. thermophilus CRL 804 and CRL 638. on the strain (van Hijum et.. (2009. al. 2001).) as well as other immune functions such as proliferation of Tlymphocytes (Forsén et. Rodríguez et al. Despite these beneficial properties. and L. bulgaricus. These effects include prebiotic effects (Dal Bello et. al. pentosus. mainly. thermophilus CRL 1190 produced a high molecular mass EPS (1500 kDa) composed of D-glucose and D-galactose. acidophilus.. 2006). al. al. Kitazawa et. The EPS could remain attached to the cell wall (capsular EPS) or be excreted into the environment in the form of slime or ropy EPS and its structure may vary depending. e.. subsp. 2002) and immunomodulatory and anti-tumor activity (Chabot et. D-galactose and Nacetilglucosamine. al. The strains CRL 1190 and CRL 87 also produced capsular polysaccharide in addition to the slime EPS in milk and was able to form ropy milk cultures similar to CRL 638. there are few studies in the literature concerning the protection of gastric epithelium by EPSproducing LAB or the role they could play in the gastric injury. al. sakei. L. among others. L. L.. L. thermophilus CRL 804 produced a low EPS (95 kDa) composed of Dgalactose and L-rhamnose.. 2001. L.. L. al. which were attributed to the high rhamnose content of the polymers (> 60%). (1994) reported anti-ulcer effects of the cell wall polysaccharide of bifidobacteria. It is known that the EPS of LAB have many functional properties.. Leuconostoc mesenteroides and Streptococcus thermophilus although it is a strain-dependent property (Mozzi et. 2006). while the strain CRL 804 was negative for both the capsular and ropy phenotypes (Mozzi et. Results obtained were similar to www. thermophilus CRL 1190 (FM-1190) as well as the EPS (EPS-1190) suspended in milk (but not in water) was the only one effective in both the therapeutic and preventive treatment of chronic gastritis in animal models. casei CRL 87 were also evaluated in vivo assays but with unsuccessful results. There are many EPS-producing LABs. and at last. The fermented milk with S.com . 2002... plantarum. al. thermophilus CRL 638. L. 1987)...intechopen. S. LABs produce two different kinds of EPS by using distinct biosynthetic pathways. helveticus. pylori adhesion to the mucus layer. L. reuteri. 2009). 1998. casei CRL 87 produced a low EPS (800 kDa) composed of D-glucose. Authors demonstrated the gastroprotector effect of fermented milk with the EPS-producing strain S. al. casei. The homopolysaccharide (HoPS) are synthesized by extracellular glycansucrases and contain only one type of sugar (generally glucose) and the hetero-polysaccharide (HePS) that are assembled by cell wall-bound glycosyl-transferases from intracellular sugar nucleotide precursors.. could avoid the H.. L. hypocholesterolemic effect (Pigeon et. activation of macrophages and induction of cytokine production (Kitazawa et. 2010) reported the first evidences on the beneficial effects of both the EPS-producing LAB strains and the biopolymer on gastritis experimental animal models using acetyl salicylic acid (ASA) as gastritis inductor. al.. delb.New Approaches in Gastritis Treatment 165 Researchs on the functional properties of metabolites produced in food by LAB during fermentation such as exopolysaccharides (EPS) increased in recent years by assigning to biopolymers potential beneficial effects on human health. The biopolymers had different physical-chemical properties: S.. Other EPS-producing strains S.

al. however.intechopen. stimulation of gastric mucus. al. 2009).com . 2002. after 7d of feeding. Diagnosis and Treatments that of OPZ but with the advantage of not having side effects. Mater et. al. so. and increase the viscosity of the serum phase (Hassan. al. Several studies reported that high molecular mass-polysaccharides of different sources (herbs. 2005). (2008) who studied the interaction between milk proteins and the EPS produced by Lactococcus lactis ssp. 1995. and the characteristics of the proteins such as charge and hydrophobicity may change during fermentation and consequently the interaction between them.. 2007). without gastritis induction. Similar research was carried out by AyalaHernandez et. 2004.166 Gastritis and Gastric Cancer – New Insights in Gastroprotection. The different effect obtained with the strains CRL 1190. it is assumed that the biopolymer may still exert its beneficial properties in the stomach even partially degraded. Yamada. al.. the beneficial effects can not be only attributed to the size of the polymer. 2008.. and increase in the number of cells producing regulatory cytokines. 2003. From results from in vivo and in vitro studies. 2008). al. al.. al. They observed that EPS www.. inmuno-stimulation. the fermented milk with S. thermophilus CRL 638 generated a great stomach inflammation in animal model. 2005. Lam et.. can not be ascribed to all EPS-producing LABs because of the complexity of the phenomenon. 2004. al. The fermented milk FM-1190 and the EPS-1190 were able to modulate the gastric inflammatory response at the immune system level (decrease in the number of cells producing pro-inflammatory cytokines. increase in gastric prostaglandin levels and partially suppression of TNF-α genes (Gao et. marine microalgae and fungi) have anti-ulcer. INF-γ and TNF-α. 2003). al... anti-inflammatory or inmunostimulatory effects related to anti-secretory activity of acid and pepsin. they also put in evidence the presence of the strain CRL 1190 in the stomach at least 15 days after finishing the administration of the fermented milk. Studies of scanning electronic microscopy (SEM) confirmed a greater secretion of gastric mucus after oral administration of FM-1190. These promising results. These confirmed previous reports concerning the ability of S.. 2005.. The FM-1190 also activated the synthesis of mucin. al. Whey proteins as α-lactalbumin would also have gastroprotector effect (Matsumoto et. CRL 804 and CRL 638 evinced that the phenomenon is strongly strain-dependent and complex. which in turn led to an increase in the thickness of the mucus layer and in the amount of mucus of the body and antrum that were decreased after ASA administration. Studies performed in in vitro gastric system evinced a partially degradation of the EPS-1190 when subjected to this harsh conditions (Mozzi et. Ushida et. Yim et. such as IL-10). Rosaneli et. (1994) with cell wall polysaccharides containing rhamnose. The recovery of the gastric defensive systems and the mucus-bicarbonate layer in animals fed FM-1190 favored the recovery of the damaged gastric mucosa. 2007). 2003. the interaction of EPS-producing LAB or the EPS with milk proteins may be a key factor in gastroprotection. al. The EPSs bind water and increase the moisture in the non-fat portion. However. 2005. al. The fermented milk with the strain S.. In contrast to the FM-1190. 2001. Guarner et. cremoris using SEM techniques. These evidences support previous reports obtained in rats with acute gastric damage which were fed with probiotic lactobacilli (Nam et. interfere with protein-protein interactions reducing the rigidity of the protein network. Vinderola & Reinheimer. thermophillus CRL 804 which produced an EPS formed by rhamnose and galactose did not display any anti-gastritis effect in contrast to the results obtained by Nagaoka et. thermophilus strains to survive the passage through the gastrointestinal tract and to exert the beneficial effects on various gastrointestinal disorders (Brigidi et. Studies on the interaction between EPS and milk proteins is complex since EPS are gradually produced during fermentation. Delorme.

. which exert different effects on the gastric mucosa tissue to alleviate the inflamed condition. However. it would be advisable to include them as adjunct in conventional treatments programs to reduce the side effect derived from the intake of drugs during long periods. the most aggressive case is due to H. pylori infection. and it is the beginning of different complication that led to ulcers and. The mode of action of probiotics and their EPS. effect associated in some cases to modulation of the immune system (cytokine regulation) and mucus stimulation. this effect is mainly required in the treatment of peptic ulcer. it is assumed that in fermented milks. pylori adhesion. Probiotic lactic acid bacteria and probiotic foods. The beneficial effects are mainly related to anti-inflammatory activity and the ability to maintain a balance in the mucus barrier and mucosal renovation.New Approaches in Gastritis Treatment 167 molecules clearly interact not only with caseins but also with whey proteins and play an active role in the formation of the aggregates. on the basis of ancient knowledge and supported by scientific evidences. Medicinal plants and their effect in different kind of diseases. also appear as a novel and promising bioalternative for gastritis treatment. or stress process (related to neurological condition) which is very common nowadays due to the population rhythm of life.g. polysaccharides and derivates in different combinations are mainly involved in gastric protection. e. inhibition of the stomach motility. when it is administered to animals. the LAB strains and the EPS together with the milk and whey proteins perform a stable threedimensional complex network. is that many of them could have side effects. such as ranitidine. pylori infection. 4. The disadvantages of employing these drugs for long periods. Phenolic compounds. infection or injury. FM-1190.. OPZ and derivates. among other cascade reactions. Considering these statements. among other properties. Recent evidences indicate that some exopolysaccharide (EPS)-producing lactic acid bacteria are able to regulate and to revert the gastritis process prompted by NSAIDs. increase in gastric pH.g. emerge as an alternative therapy to cure or prevent gastric disorders. Conclusion Gastritis is the most common illness associated to the stomach. The disease is due to different causes as an imbalanced diet. e. www. thus avoiding inflammation and or making the mucus barrier stronger. which is attached to the gastric mucosa preferably to the mucus layer. gastric cancer. and stimulation of mucus production. the EPS could interact with the mucosal tissue exerting an inmunomodulador effect. or by displaying anti-H. The mode of action of probiotic LAB strains and their EPS in gastritis has not yet been completely elucidated.com . The increase in gastric pH is a necessary condition to stop autodigestive processes and support mucosal healing in the extreme environment of the gastric lumen. pylori and inhibit its adhesion to mucus barrier thus avoiding the infection process. Thus. by stimulation of the mucus synthesis. thus helping the stomach to balance the acid condition when there is an inflammation. which involves modulation of the immune system. is under study. which beneficial effects on the gut health are strongly supported by scientific evidences. Other drugs are also used. which could also affect H. and antibiotics in the case of H. in the worst case. The biopolymers could also interact with H. pylori effects. Considering the beneficial effects of these bio-treatments in gastritis processes. a property that is mainly related to the EPS produced by specific strains.intechopen. intake of aggressive agents. Allopathic treatment of gastritis includes different conventional drugs acting as inhibitors of the proton pump and of the acid gastric production.

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65. K-ras mutations. pylori infection. ISBN: 978-953-307-375-0. These chapters discuss the serum pepsinogen test.Gastritis and Gastric Cancer . which consider the role of neuroendocrine cells in gastric disease. Diagnosis and Treatments. and the gastrokine-1 protein in cancer progression. cell kinetics. Diagnosis and Treatments Edited by Dr. pylori lipopolysaccharide.com/books/gastritis-and-gastric-cancer-new-insights-in-gastroprotection-diagnosis-andtreatments/new-approaches-in-gastritis-treatment InTech Europe University Campus STeP Ri Slavka Krautzeka 83/A 51000 Rijeka.).New Insights in Gastroprotection. New Approaches in Gastritis Treatment. apoptosis and autophagy in H.New Insights in Gastroprotection. Office Block. pylori related gastritis. Gastritis and Gastric Cancer . September. The final part presents the effects of cancer risk factors associated with H. The first part of the book covers topics related to the pathophysiology of gastric mucosal defense system and gastritis including the gastroprotective function of the mucus. and H. the role of antioxidants and phytotherapy in gastric disease. pylori infection. DNA methylation in H. 2011 This book is a comprehensive overview of invited contributions on Helicobacter pylori infection in gastritis and gastric carcinogenesis. as well as the roles of several bacterial genes (cagA. Marta Medici and Graciela Font de Valdez (2011). feel free to copy and paste the following: Guillermo Marcial. cagT.intechopen.intechopen. Croatia Phone: +385 (51) 770 447 Fax: +385 (51) 686 166 www. 200040. vacA and dupA) as virulence factors in gastric cancer. 296 pages Publisher InTech Published online 15. Available from: http://www. Hotel Equatorial Shanghai No. Yan An Road (West). The next chapters deal with molecular pathogenesis and treatment. 2011 Published in print edition September. Paola Tonino (Ed. InTech. How to reference In order to correctly reference this scholarly work. Shanghai. China Phone: +86-21-62489820 Fax: +86-21-62489821 . Dr. Cecilia Rodríguez.com InTech China Unit 405. Paola Tonino ISBN 978-953-307-375-0 Hard cover. the capsaicinsensitive afferent nerves and the oxidative stress pathway involved in inflammation.