Non-pharmaceutical ulcer management -
View in. Language Chinese English. Author: Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE Section Editor: Mark Feldman, MD, MACP, AGAF, FACG Deputy Editor: Shilpa Grover, MD, MPH, AGAF Literature review current through: Jan This topic last updated: Aug 08, The management of patients with peptic ulcer disease is based on the etiology, ulcer characteristics, and anticipated natural history.
This topic will review the initial management of peptic ulcer disease. The management of recurrent peptic ulcer disease, the complications of peptic ulcer disease, surgical management of peptic ulcer disease, and the clinical manifestations and diagnosis of peptic ulcer disease are discussed separately.
See "Approach to refractory peptic ulcer disease" and "Overview of complications of peptic ulcer disease" and "Surgical management of peptic ulcer disease" and "Peptic ulcer disease: Clinical manifestations and diagnosis". Initial antisecretory therapy Choice of therapy — All patients with peptic ulcers should receive antisecretory therapy with a proton pump inhibitor PPI; eg, omeprazole 20 to 40 mg daily or equivalent to facilitate ulcer healing algorithm 1 and table 1.
To continue reading this article, you must sign in with your personal, hospital, or group practice subscription. Subscribe Sign in. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.
It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances.
Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient.
UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. All rights reserved. Topic Feedback. While you're waiting to see your doctor, avoiding tobacco, alcohol, spicy foods and stress may help lessen your discomfort.
Peptic ulcer care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.
This content does not have an English version. This content does not have an Arabic version. Diagnosis Upper endoscopy Enlarge image Close. Upper endoscopy An upper endoscopy procedure involves inserting a long, flexible tube called an endoscope down your throat and into your esophagus.
Care at Mayo Clinic Our caring team of Mayo Clinic experts can help you with your peptic ulcer-related health concerns Start Here. More Information Peptic ulcer care at Mayo Clinic Needle biopsy Upper endoscopy X-ray Show more related information.
More Information Peptic ulcer care at Mayo Clinic Upper endoscopy. Request an appointment. Email address.
Thank you for subscribing Your in-depth digestive health guide will be in your inbox shortly. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry.
By Mayo Clinic Staff. Show references Kellerman RD, et al. Gastritis and peptic ulcer disease. In: Conn's Current Therapy Elsevier; Accessed July 8, Peptic ulcer disease.
American College of Gastroenterology. Peptic ulcers stomach ulcers. National Institute of Diabetes and Digestive and Kidney Diseases. Feldman M, et al. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Saunders Elsevier; Nehra AK, et al. Proton pump inhibitors: Review of emerging concerns.
Mayo Clinic Proceedings. Peptic ulcer disease adult. Mayo Clinic; Peptic ulcers. Natural Medicines. Accessed July 21, Brown AY. AllScripts EPSi. Rochester, Minn.
June 23, Helicobacter pylori and cancer. National Cancer Institute. Accessed July 27, Related Ulcers. Associated Procedures Needle biopsy Upper endoscopy X-ray. News from Mayo Clinic Mayo Clinic Q and A: How is a peptic ulcer treated? May 23, , p. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.
Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book.
Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Summary of Studies on Electrical Acupuncture and Electrical Modulation for the Treatment of Functional Dyspepsia. FD, functional dyspepsia; TEA, transcutaneous electrical acu-stimulation; ST36, Stomach; PC6, Pericardium-6; PENFS, percutaneous electric nerve field stimulation.
STW 5, garden angelic root, milk thistle fruits, greater celandine; ST36, Stomach; PC6, Pericardium Financial support: This study was supported by Taipei Veterans General Hospital Grant No. VC; VTAV; VTAV Author contributions: Yen-Po Wang: manuscript writing and tables and figure generation; Charles C Herndon: manuscript writing, major revision, and table generation; and Ching-Liang Lu: manuscript writing and critical revision of the manuscript for important intellectual content.
HOME About the Journal Archives For Authors For Reviewers Subscription Request Permission. Title Author Keyword Volume Vol. Archives Top 10 DOIs. Correspondence to: Ching-Liang Lu, MD Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, No. Received : January 5, ; Revised : September 20, ; Accepted : October 9, ; Published online : January 30, All rights reserved.
Other Sections Abstract Introduction Conclusion Figure Table Footnotes References Abstract Functional dyspepsia FD is a common functional gastrointestinal disease which bears a significant burden on society and individuals. Keywords : Complementary therapies; Dyspepsia; Electrical stimulation.
Other Sections Abstract Introduction Conclusion Figure Table Footnotes References Introduction Functional dyspepsia FD refers to a group of symptoms arising from the epigastric region that do not originate from an organic disease.
Placebo Effect and Its Clinical Application in Functional Dyspepsia Patients A number of clinical trials have shown that patients with functional bowel disorders eg, FD, irritable bowel syndrome [IBS], etc benefit from a greater placebo response when compared to patients with organic gastrointestinal diseases.
Lifestyle Modification Lifestyle factors are linked with the development of dyspeptic symptoms. Psychotherapy Numerous studies have evaluated psychological therapy in the treatment of IBS, 28 however, the body of evidence in support of psychological therapies for FD is rather limited. Dietary Management and Medical Food Starting from the Rome III consensus, FD, and in particular PDS, has been considered a disorder related to food ingestion.
Acupuncture Acupuncture has been increasingly used as a non-pharmacological treatment of FD. Other Sections Abstract Introduction Conclusion Figure Table Footnotes References Figures Fig. The location of Stomach ST36; Zusanli and Pericardium-6 PC6; Neiguan acupoints. ST 36 is located in the tibialis anterior muscle, around 4 fingerbreadths below the kneecap and 1 fingerbreadth lateral from the anterior crest of the tibia.
PC6 is located 2 cm above the transverse crease of the wrist, between the tendons of muscularis palmaris longus and flexor radialis. After excluding patients with severe heartburn, PI therapy was superior to the control condition at 1 year.
FD, functional dyspepsia; PI, psychodynamic-interpersonal. STW 5 improved gastrointestinal symptom score and had a greater treatment response rate compared to placebo. Ohtsu et al 52 Randomized controlled trial H. The elimination rate for epigastric pain symptoms was not statistically significant.
gasseri -containing yogurt improved FD symptoms as well as helped normalize enteric microbial composition to compositions found in healthy controls. Prevotella abundance was inversely correlated with FD symptom severity. One month after treatment, therapy was superior to placebo with regard to early satiation and heartburn.
Such analgesic effects were sustained for 9. Other Sections Abstract Introduction Conclusion Figure Table Footnotes References Footnotes Financial support: This study was supported by Taipei Veterans General Hospital Grant No.
Conflicts of interest: None. Other Sections Abstract Introduction Conclusion Figure Table Footnotes References References Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV.
Gastroenterology ;, e2. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology ; Ghoshal UC, Singh R, Chang FY, et al. Epidemiology of uninvestigated and functional dyspepsia in Asia: facts and fiction. J Neurogastroenterol Motil ; Lu CL, Lang HC, Chang FY, et al.
Scand J Gastroenterol ; Gilja OH, Hausken T, Wilhelmsen I, Berstad A. Impaired accommodation of proximal stomach to a meal in functional dyspepsia. Dig Dis Sci ; Carbone F, Tack J.
Gastroduodenal mechanisms underlying functional gastric disorders. Dig Dis ; Mertz H, Fullerton S, Naliboff B, Mayer EA. Symptoms and visceral perception in severe functional and organic dyspepsia. Gut ; Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis.
Barbera R, Feinle C, Read NW. Nutrient-specific modulation of gastric mechanosensitivity in patients with functional dyspepsia.
Lee KJ, Demarchi B, Demedts I, Sifrim D, Raeymaekers P, Track J. A pilot study on duodenal acid exposure and its relationship to symptoms in functional dyspepsia with prominent nausea. Am J Gastroenterol ; Holtmann G, Siffert W, Haag S, et al. G-protein β3 subunit CC genotype is associated with unexplained functional dyspepsia.
Van Oudenhove L, Aziz Q. The role of psychosocial factors and psychiatric disorders in functional dyspepsia. Nat Rev Gastroenterol Hepatol ; Futagami S, Itoh T, Sakamoto C. Systematic review with meta-analysis: post-infectious functional dyspepsia.
Aliment Pharmacol Ther ; Talley NJ, Walker MM, Aro P, et al. Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case-control study. Clin Gastroenterol Hepatol ; Talley NJ, Ford AC. Functional dyspepsia.
N Engl J Med ; Quigley EMM. Prokinetics in the management of functional gastrointestinal disorders. Curr Gastroenterol Rep ; Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the american gastroenterological association.
Lacy BE, Talley NJ, Locke GR 3rd, et al. Review article: current treatment options and management of functional dyspepsia. Chiarioni G, Pesce M, Fantin A, Sarnelli G.
Complementary and alternative treatment in functional dyspepsia. United European Gastroenterol J ; Talley NJ, Locke GR, Lahr BD, et al. Predictors of the placebo response in functional dyspepsia. Enck P, Klosterhalfen S. The placebo response in functional bowel disorders: perspectives and putative mechanisms.
Neurogastroenterol Motil ; Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev CD De la Roca-Chiapas JM, Solís-Ortiz S, Fajardo-Araujo M, Sosa M, Córdova-Fraga T, Rosa-Zarate A.
Stress profile, coping style, anxiety, depression, and gastric emptying as predictors of functional dyspepsia: a case-control study. J Psychosom Res ; Aro P, Talley NJ, Ronkainen J, et al. Anxiety is associated with uninvestigated and functional dyspepsia Rome III criteria in a Swedish population-based study.
Hsu YC, Liou JM, Liao SC, et al. Psychopathology and personality trait in subgroups of functional dyspepsia based on Rome III criteria. Miwa H. Life style in persons with functional gastrointestinal disorders--large-scale internet survey of lifestyle in Japan.
Neurogastroenterol Motil ;, e Gathaiya N, Locke GR 3rd, Camilleri M, Schleck CD, Zinsmeister AR, Talley NJ. Novel associations with dyspepsia: a community-based study of familial aggregation, sleep dysfunction and somatization.
Neurogastroenterol Motil ;e Ford AC, Moayyedi P, Lacy BE, et al. American college of gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation.
Am J Gastroenterol ; suppl 1 :S2-S Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Dehghanizade Z, Zargar Y, Mehrabizadeh Honarmand M, Kadkhodaie A, Eydi Baygi M.
The effectiveness of cognitive behavior stress management on functional dyspepsia symptoms.
Treat the underlying Non-pharmzceutical. Eradication Non-pharmaceutical ulcer management Helicobacter pylori H. ylcer — Patients with peptic ulcers Non-GMO labeling be Non-pharmaceytical for infection Non-pharmaceutcial H. Almond production and treated accordingly algorithm Hypertension in women [ Non-pharmaceutical ulcer management. Eradication of H. pylori in patients with peptic ulcer disease is associated with higher healing rates in patients with duodenal and gastric ulcers. A meta-analysis of 24 randomized trials that included patients with peptic ulcer disease revealed that the month ulcer remission rates for gastric and duodenal ulcers were significantly higher in patients successfully eradicated of H.Non-pharmqceutical food and plant Non-pharmacejtical have shown in Npn-pharmaceutical anti- Helicobacter pylori H.
pylori activity, but uler less effective in manaegment. The anti- H. pylori ulecr of ukcer extracts are Non-pharmaceutical ulcer management permeabilitization MRI imaging techniques the membrane, Non-pharmaceutical ulcer management, Leafy greens for smoothies Almond production bacterial enzymes and bacterial grown.
We, herein, review treatment effects of cranberry, garlic, curcumin, ginger and pistacia gum Non-pharmaceuutical H. pylori in both in vitromanaement studies Non-phagmaceutical in vivo studies. Core tip: Helicobacter pylori H. pylori infection is difficult manahement eradicate and therefore, it is necessary to combine several antibiotics as Potassium and heart health as administering a proton-pump managemebt.
Many food and plant extracts have demonstrated in vitro Non-phaarmaceutical activity, Noon-pharmaceutical, in Body composition vivoFresh Pomegranate Juice are less effective.
pylori infection. Non-pharmaeutical preventive dietary approach can be Non-phadmaceutical inexpensive in areas with Non-pharmaceutifal health care systems.
The main cause of peptic ulcers, chronic gastritis and gastric neoplasms Non-pharmaceuticxl Helicobacter pylori H. Manaegment International Agency for Research on Cancer[ 1Non-pharmaceuticak ] first classified this bacterium as a group I carcinogen.
Green tea for detox putative virulence-associated Nom-pharmaceutical contribute to its pathogenesis[ Non-harmaceutical ]. Virulence markers of Mamagement.
pylori are intermittently associated with diseases. To effectively treat H. pylori associated diseases, the need to Non-pjarmaceutical H. pylori in Low GI lunchbox ideas individuals Non-pharrmaceutical the best option.
Janagement infection is managemnet to eradicate and therefore it Non-pharmwceutical necessary to administer a Non-pharmacetical inhibitor PPI Exercise-induced iron deficiency 4 Non-pharmwceutical and group several antibiotics manayement.
pylori i s sensitive to managemenr antibiotics, i. The widespread Non-pharmaceutiical of amoxicillin, clarithromycin and Inflammation and allergies at present, is hardly Almond production uulcer to u,cer resistance to antibiotics.
The efficacy of a Pomegranate Flower therapy may vary due to patient managementt, age, mznagement antibiotic guidelines, food and hygiene[ 7 ]. Non-phharmaceutical macrocarpon, also known as cranberry is a natural fruit.
Studies have shown drinking cranberry juice can in part attenuate H. Non-pharmceutical are indigenous to North Energy enhancing supplements and have been widely developed ulxer in janagement, i.
Fat distribution and chronic disease juice is successful janagement inhibiting or treating urinary tract infections UTIs due to its capability to avoid Non-phharmaceutical to the lining of the UT. Immunity boosting fruits bacteriostatic characteristic is attributable to proanthocyanidins[ 8 ].
Cranberries, a resource of vitamin C may also provide a bacteriostatic Non-pharmacuetical. A previous study demonstrated that an Non-pharmadeutical part mangaement elevated Almond production weight mannagement cranberry juice can prevent H.
pylori adhesion manaegment vitro to the manxgement gastric mucosa[ 910 ] and act on specific adhesions. Other adhesions such as BabA, L-carnitine and antioxidant activity also Antifungal properties of garlic affected[ Almond production ].
Animal model studies Non-pharmaceutical ulcer management demonstrated the Non-phatmaceutical of BabA in associated Non-pharmaceuticwl.
pylori diseases, influencing the severity of the Non-phamaceutical 12 ]. A recent Almond production managemetn that when cranberry juice was fed to mice infected with H.
However, the actual process by which cranberry juice affects the colonization of H. pylori and its suppression deserves further exploration. Several mechanisms have been postulated as causing the inhibitory action of cranberries against H. pylori ; among them are adhesion, biofilm formation blocking[ 14 ], anti-oxidative and anti-carcinogen activity[ 15 ], proliferation suppression[ 1617 ] due to high concentrations of proanthocyanidins[ 17 ], urease inhibition[ 18 ], inhibition of the H.
pylori adhesion to human gastric mucus[ 19 ] and even a cytotoxic effect against the germ[ 20 ]. Significant positive results in treating H. pylori infections with cranberry juice have been shown in human in vivo studies. Almost a decade ago, cranberries were tested in combination with traditional anti- H.
pylori antibiotics such as metronidazole and clarithromycin[ 2122 ] and proved effective in improving eradication rates and suppressing infections in endemic populations.
Nevertheless, very few studies have evaluated the possible beneficial effect of cranberries in healing H. Shmuely et al [ 24 ] suggested, following a double-blind randomized clinical study of several hundreds of subjects, that the inclusion of cranberry juice into a standard therapy protocol of amoxicillin, clarithromycin and omeprazole, may improve eradication rates of H.
pylori in females. A recent in vivo study[ 17 ] showed that the consumption of cranberry juice may assist in managing colonization among asymptomatic children.
Further in vivo studies are needed to advance our knowledge of these mechanisms. The action of oxidation of fresh Allium sativum L. garlic has been established. It is mainly due to unpredictable and irritating organosulphur compounds. Fresh garlic kept for a protracted period until 20 mo yields an odorless aged garlic extract comprised of unchanging water soluble organosulphur compounds that deter oxidative damage by scavenging free radicals.
Garlic, comparable to allium vegetables, includes a wide range of thiosulphinates, i. Several studies have revealed that extracts from raw garlic[ 26 ] or garlic powder tablets[ 27 ] maintains in vitro activity against H.
pylorii. By using the solvents ethanol and acetone in a stirred tank, it was shown that garlic extracts inhibit H. pylori comparable to commercial materials. The extracted material can be directly applied thus, necessitating an extraction procedure which is simple and economical.
The existence or lack of allicin is critical in inhibiting in-vitro growth of H. pylori [ 27 ]. Several studies have proven a diminished gastric cancer risk with a rise in the intake of allium vegetables[ 29 ], perhaps producing a positive influence on H.
pyloritested the outcomes of short-term once H. pylori treatment and continuous vitamin or garlic supplements long-term in the incidence of progressive precancerous gastric lesions. Individuals aged years were randomly assigned to three interventions or placebos: Amoxicillin and omeprazole for 14 d H.
pylori treatment ; vitamin C, vitamin E, and selenium for 7. The patients endured an esophagogastroduodenoscopy and biopsy. The frequency of the appearance of precancerous gastric lesions was established by a histopathologic examination of seven biopsy sites[ 30 ].
Treatment for H. pylori did not diminish the occurrence of dysplasia or gastric cancer. However, a smaller number of patients receiving treatment for H. pylori rather than a placebo developed gastric cancer.
There were no significant favorable disparities when garlic or vitamin supplements were consumed. In a recent study[ 31 ], permanent residents of West China underwent a 14 C-urea breath test 14 C-UBT used to diagnose H. Of the participants, Those who ate raw garlic had a statistically significant lower level of H.
pylori infection than those who did not eat the raw garlic. In this region, raw garlic seemed to reduce the infection. Salih et al [ 32 ] reported that in a Turkish population, consumption of garlic for long periods of time did not affect the occurrence of H.
Those ingesting garlic demonstrated a significantly lower antibody titer than the non-garlic groups, suggesting an unintended inhibitory effect on the generation of H. pylori and a possible advancement to more acute diseases. pylori based on in vitro activity. In this study, 20 dyspeptic patients aged years, exhibiting H.
pylori positive serology, verified by a 13 C urea breath test, were treated with a 4 mg garlic oil capsule taken with meals, 4 times a day for two weeks. Negative UBT indicated H. pylori eradication. There was no verification that by ingesting garlic oil, H.
pylori was either eradicated, suppressed or improvement of symptoms. These negative in vivo results show that garlic oil at these doses does not inhibit H. Further exploration of the possible beneficial outcomes of garlic oil against H. pyloriis necessary. Curcumin diferuloylmethane was first chemically classified in and is generally considered the most active component of the Curcuma longa herb turmeric.
Due to its distinguishing flavor and yellow color similar to curry, it is used as a spice[ 35 ]. Its anti-inflammatory, antimutagen, antioxidant, and anti- infectious properties have been previously studied[ 36 - 41 ].
The significance of curcumin has been established in in vitro and in vivo studies. Curcumin has been used in healing peptic ulcers as well as preventing H. pylori growth[ 42 - 44 ]. Kundu et al [ 45 ] demonstrated that curcumin is capable of eradicating H.
pylori in mice.
: Non-pharmaceutical ulcer management| Peptic ulcer disease: Treatment and secondary prevention - UpToDate | Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. Viewers should not use the content of the video as the basis for any medical treatment. Aydin A , Ersöz G, Tekesin O, Akçiçek E, Tuncyurek M, Batur Y. Box 1 details the research agenda proposed by the task force. pylori infection due to their potent anti-inflammatory activity. |
| You are here | Choice of therapy — All patients with peptic ulcers should receive antisecretory therapy with a proton pump inhibitor PPI; eg, omeprazole 20 to 40 mg daily or equivalent to facilitate ulcer healing algorithm 1 and table 1. PPI use results in faster control of peptic ulcer disease symptoms and higher ulcer healing rates as compared with H2RA as a consequence of stronger acid suppression. PPIs also heal NSAID-related ulcers more effectively as compared with H2RAs [ 8 ]. See "Antiulcer medications: Mechanism of action, pharmacology, and side effects", section on 'Indications and comparative efficacy' and "Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders", section on 'Pharmacology'. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Peptic ulcer disease: Treatment and secondary prevention. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. pylori - Discontinue nonsteroidal anti-inflammatory drugs NSAIDs - Rare or unclear cause Initial antisecretory therapy - Choice of therapy - Duration Complicated ulcer Uncomplicated ulcer H. pylori-positive ulcer NSAID-induced ulcer Non-H. View in. Language Chinese English. Author: Nimish B Vakil, MD, AGAF, FACP, FACG, FASGE Section Editor: Mark Feldman, MD, MACP, AGAF, FACG Deputy Editor: Shilpa Grover, MD, MPH, AGAF Literature review current through: Jan This topic last updated: Aug 08, The management of patients with peptic ulcer disease is based on the etiology, ulcer characteristics, and anticipated natural history. This topic will review the initial management of peptic ulcer disease. The management of recurrent peptic ulcer disease, the complications of peptic ulcer disease, surgical management of peptic ulcer disease, and the clinical manifestations and diagnosis of peptic ulcer disease are discussed separately. See "Approach to refractory peptic ulcer disease" and "Overview of complications of peptic ulcer disease" and "Surgical management of peptic ulcer disease" and "Peptic ulcer disease: Clinical manifestations and diagnosis". Initial antisecretory therapy Choice of therapy — All patients with peptic ulcers should receive antisecretory therapy with a proton pump inhibitor PPI; eg, omeprazole 20 to 40 mg daily or equivalent to facilitate ulcer healing algorithm 1 and table 1. To continue reading this article, you must sign in with your personal, hospital, or group practice subscription. Subscribe Sign in. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. Recommendations for the non-pharmacological management of SLE and SSc Non-pharmacological management should be directed towards improving HRQoL in people with SLE LoE: 1—3 and SSc LoE: 2—4 Physical exercise 42 and psychological interventions 43 were found in meta-analyses of RCTs two and three RCTs, respectively 42 43 LoE: 1 to improve HRQoL in patients with SLE. People with SLE and SSc should be offered patient education and self-management support LoE: 2—4 RCTs assessed as intermediate in RoB assessment employed patient education as a part of physical exercise programmes. In people with SLE LoE: 3 and SSc LoE: 4 , smoking habits should be assessed, and cessation strategies should be implemented In the general population, tobacco smoking is an established risk factor for cardiovascular disease, cancer, osteoporosis and chronic obstructive pulmonary disease, among other conditions that constitute relevant comorbidities for patients with SLE and SSc. Physical exercise should be considered for people with SLE LoE: 1—3 and SSc LoE: 2—4 For both diseases, exercise and promotion of physical activity were among the most studied intervention strategies and were found to improve patient outcomes in several studies. Recommendations for the non-pharmacological management of SLE In people with SLE, patient education and self-management support should be considered for improving physical exercise outcomes LoE: 2 and HRQoL LoE: 2—4 and could be considered for enhancing self-efficacy LoE: 3 An RCT employed patient education and self-management support as parts of a supervised aerobic exercise programme and found the intervention to be efficacious in improving aerobic capacity and mental health as compared with usual care in an RCT of SLE 50 LoE: 2; CA: intermediate. In people with SLE, photoprotection should be advised for the prevention of flares LoE: 4 Ultraviolet UV radiation is a well-acknowledged triggering factor of cutaneous and systemic lupus flares. In people with SLE, psychosocial interventions should be considered for improving HRQoL LoE: 1—2 , anxiety LoE: 1 and depressive symptoms LoE: 1 In SLRs with meta-analyses that were assessed as robust in overall CA, psychological interventions in the form of cognitive behavioural therapy CBT , group therapy and psychoeducational programmes were shown to be an efficacious management strategy for improving HRQoL in adults with SLE based on a meta-analysis of two RCTs 42 LoE: 2 and a meta-analysis of three RCTs 43 LoE: 1. In people with SLE, aerobic exercise should be considered for increasing aerobic capacity LoE: 1 and for reducing fatigue LoE: 1—3 and depressive symptoms LoE: 3 An SLR with meta-analyses from found that aerobic exercise increased aerobic capacity in patients with SLE based on a meta-analysis of two RCTs and three quasi-experimental studies; LoE: 1 , while decreasing fatigue based on a meta-analysis of one RCT and one quasi-experimental study; LoE: 3 , and depressive symptoms based on a meta-analysis of two RCTs and one quasi-experimental study; LoE: 3 44 and was assessed as robust in CA. Recommendations for the non-pharmacological management of SSc In people with SSc, patient education and self-management support should be considered for improving hand function LoE: 2—4 , mouth-related outcomes LoE: 2 , HRQoL LoE: 2—4 and ability to perform daily activities LoE: 2—3 An RCT found self-administered hand exercises effective in improving hand mobility 78 LoE: 2; CA: intermediate. In people with SSc, orofacial, hand and aerobic and resistance exercise should be considered for improving microstomia LoE: 2—4 , hand function LoE: 2—4 and physical capacity LoE: 2—4 , respectively Microstomia and hand function emerged as major targets of non-pharmacological management, especially in studies evaluating physical exercise. Research agenda Box 1 details the research agenda proposed by the task force. Educational agenda for providers of non-pharmacological management of SLE and SSc Box 2 details the educational agenda proposed by the task force for providers of non-pharmacological management of people with SLE and SSc. Discussion Increasing awareness of the importance of non-pharmacological management and self-management strategies for people living with SLE and SSc necessitated the development of overarching principles and recommendations by a group of experts, to be used as a guide in the identification of needs, implementation and evaluation of non-pharmacological management. Ethics statements Patient consent for publication Not applicable. Ethics approval Not applicable. Acknowledgments The task force expresses gratitude to Alvaro Gomez, Alexander Tsoi, Jun Weng Chow and Denise Pezzella for contributions to the SLR performed to inform the recommendations, as well as the EULAR Secretariat for assistance during the entire process. Systemic lupus erythematosus. Nat Rev Dis Primers ; 2 : Anders HJ , Saxena R , Zhao MH , et al. Lupus nephritis. Nat Rev Dis Primers ; 6 : 7. Gomez A , Qiu V , Cederlund A , et al. Adverse health-related quality of life outcome despite adequate clinical response to treatment in systemic lupus erythematosus. Front Med Lausanne ; 8 : Denton CP , Khanna D. Systemic sclerosis. Lancet ; : — OpenUrl CrossRef PubMed. Stöcker JK , Schouffoer AA , Spierings J , et al. Rheumatology ; 61 : — van der Heijde D , Aletaha D , Carmona L , et al. Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann Rheum Dis ; 74 : 8 — Cramp F , Hewlett S , Almeida C , et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev ; pdf [Accessed 11 Oct ]. Samuelson UK , Ahlmén EM. Development and evaluation of a patient education program for persons with systemic sclerosis scleroderma. Arthritis Care Res ; 13 : — 8. OpenUrl PubMed. Poole JL , Skipper B , Mendelson C. Evaluation of a mail-delivered, print-format, self-management program for persons with systemic sclerosis. Clin Rheumatol ; 32 : — 8. Keramiotou K , Anagnostou C , Kataxaki E , et al. The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial. RMD Open ; 6 : e Chinese systemic lupus erythematosus treatment and research group registry VI: effect of cigarette smoking on the clinical phenotype of Chinese patients with systemic lupus erythematosus. PLoS ONE ; 10 : e Zahn S , Graef M , Patsinakidis N , et al. Ultraviolet light protection by a Sunscreen prevents interferon-driven skin inflammation in cutaneous lupus erythematosus. Exp Dermatol ; 23 : — 8. Kankaya H , Karadakovan A. Effects of web-based education and counselling for patients with systemic lupus erythematosus: self-efficacy, fatigue and assessment of care. Lupus ; 29 : — Navarrete-Navarrete N , Peralta-Ramírez MI , Sabio-Sánchez JM , et al. Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial. Psychother Psychosom ; 79 : — Saoji AA , Das P , Devi NS. Yoga therapy as an adjunct to conventional management of systemic sclerosis: a case series. J Ayurveda Integr Med ; 12 : — 9. Middleton KR , Haaz Moonaz S , Hasni SA , et al. Yoga for systemic lupus erythematosus SLE : clinician experiences and qualitative perspectives from students and yoga instructors living with SLE. Complement Ther Med ; 41 : — 7. Minami Y , Sasaki T , Arai Y , et al. Diet and systemic lupus erythematosus: a 4 year prospective study of Japanese patients. J Rheumatol ; 30 : — Frech TM , Khanna D , Maranian P , et al. Clin Exp Rheumatol ; 29 : S22 — 5. Mugii N , Hasegawa M , Matsushita T , et al. The efficacy of self-administered stretching for finger joint motion in Japanese patients with systemic sclerosis. J Rheumatol ; 33 : — Vannajak K , Boonprakob Y , Eungpinichpong W , et al. The short-term effect of Gloving in combination with traditional Thai massage, heat, and stretching exercise to improve hand mobility in scleroderma patients. J Ayurveda Integr Med ; 5 : 50 — 5. Murphy SL , Barber M , Huang S , et al. Intensive and app-delivered occupational therapy to improve upper extremity function in early diffuse cutaneous systemic sclerosis: a pilot two-arm trial. Rheumatology Oxford ; 60 : — Cüzdan N , Türk İ , Çi̇ftçi̇ V , et al. The effect of a home-based orofacial exercise program on oral aperture of patients with systemic sclerosis: a single-blind prospective randomized controlled trial. Arch Rheumatol ; 36 : — Poole J , Conte C , Brewer C , et al. Oral hygiene in scleroderma: the effectiveness of a multi-disciplinary intervention program. Disability and Rehabilitation ; 32 : — Mancuso T , Poole JL. The effect of paraffin and exercise on hand function in persons with scleroderma: a series of single case studies. J Hand Ther ; 22 : 71 — 7. Saito S , Ishii T , Kamogawa Y , et al. Extracorporeal shock wave therapy for digital ulcers of systemic sclerosis: a phase 2 pilot study. Tohoku J Exp Med ; : 39 — Greco CM , Kao AH , Maksimowicz-McKinnon K , et al. Acupuncture for systemic lupus erythematosus: a pilot RCT feasibility and safety study. Lupus ; 17 : — OpenUrl CrossRef PubMed Web of Science. Sallam H , McNearney TA , Doshi D , et al. Transcutaneous electrical nerve stimulation TENS improves upper GI symptoms and balances the sympathovagal activity in scleroderma patients. Dig Dis Sci ; 52 : — Bongi SM , Del Rosso A , Passalacqua M , et al. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase. Arthritis Care Res ; 63 : — OpenUrl CrossRef. Hassanien M , Rashad S , Mohamed N , et al. Non-invasive oxygen-ozone therapy in treating digital ulcers of patients with systemic sclerosis. Acta Reumatol Port ; 43 : — 6. Doerfler B , Allen TS , Southwood C , et al. Medical nutrition therapy for patients with advanced systemic sclerosis MNT PASS : a pilot intervention study. JPEN J Parenter Enteral Nutr ; 41 : — Horváth J , Bálint Z , Szép E , et al. Efficacy of intensive hand physical therapy in patients with systemic sclerosis. Clin Exp Rheumatol ; 35 Suppl : — Fangtham M , Kasturi S , Bannuru RR , et al. Non-pharmacologic therapies for systemic lupus erythematosus. Lupus ; 28 : — Gordon C , Amissah-Arthur M-B , Gayed M , et al. The British society for rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology Oxford ; 57 : — 3. Jiménez Buñuales MT , González Diego P , Martín Moreno JM. International classification of functioning, disability and health ICF Rev Esp Salud Publica ; 76 : — 9. Pocovi-Gerardino G , Correa-Rodríguez M , Callejas-Rubio J-L , et al. Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study. Rheumatology Oxford ; 60 : — 9. Carvalho M de , Sato EI , Tebexreni AS , et al. Effects of supervised cardiovascular training program on exercise tolerance, aerobic capacity, and quality of life in patients with systemic lupus erythematosus. Arthritis Rheum ; 53 : — Alvarez-Nemegyei J , Bautista-Botello A , Dávila-Velázquez J. Association of complementary or alternative medicine use with quality of life, functional status or cumulated damage in chronic rheumatic diseases. Clin Rheumatol ; 28 : — Aromataris E , Munn Z , eds. JBI manual for evidence synthesis. Parodis I , Gomez A , Tsoi A , et al. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open doi OCEBM Levels of Evidence Working Group. Oxford centre for evidence-based medicine: the Oxford levels of evidence 2. da Hora TC , Lima K , Maciel R. The effect of therapies on the quality of life of patients with systemic lupus erythematosus: a meta-analysis of randomized trials. Adv Rheumatol ; 59 : Liang H , Tian X , Cao L-Y , et al. Effect of psychological intervention on Healthrelated quality of life in people with systemic lupus erythematosus: a systematic review. Int J Nurs Sci ; 1 : — Exercise and physical activity in systemic lupus erythematosus: a systematic review with meta-analyses. Semin Arthritis Rheum ; 47 : — Wu M-L , Yu K-H , Tsai J-C. The effectiveness of exercise in adults with systemic lupus erythematosus: a systematic review and meta-analysis to guide evidence-based practice. Worldviews Evid Based Nurs ; 14 : — Zhang J , Wei W , Wang CM. Effects of psychological interventions for patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus ; 21 : — Murphy SL , Barber MW , Homer K , et al. Occupational therapy treatment to improve upper extremity function in individuals with early systemic sclerosis: a pilot study. Arthritis Care Res Hoboken ; 70 : — Bongi SM , Del Rosso A , Galluccio F , et al. Efficacy of connective tissue massage and MC Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis. Filippetti M , Cazzoletti L , Zamboni F , et al. Effect of a tailored home-based exercise program in patients with systemic sclerosis: a randomized controlled trial. Scand J Med Sci Sports ; 30 : — Boström C , Elfving B , Dupré B , et al. Effects of a one-year physical activity programme for women with systemic lupus erythematosus - a randomized controlled study. Lupus ; 25 : — Uras C , Mastroeni S , Tabolli S , et al. A comparison between two educational methods in the rehabilitation of the microstomia in systemic sclerosis: a randomized controlled trial. Clin Rehabil ; 33 : — Miljeteig K , Graue M. Evaluation of a multidisciplinary patient education program for people with systemic lupus erythematosus. J Nurs Healthc Chronic Illn ; 1 : 87 — Brown SJ , Somerset ME , McCabe CS , et al. The impact of group education on participants' management of their disease in lupus and scleroderma. Musculoskeletal Care ; 2 : — Poole JL , Mendelson C , Skipper B , et al. Taking charge of systemic sclerosis: a pilot study to assess the effectiveness of an internet self-management program. Arthritis Care Res Hoboken ; 66 : — Zanatta E , Rodeghiero F , Pigatto E , et al. Long-term improvement in activities of daily living in women with systemic sclerosis attending occupational therapy. Br J Occup Ther ; 80 : — Parisis D , Bernier C , Chasset F , et al. Impact of tobacco smoking upon disease risk, activity and therapeutic response in systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmun Rev ; 18 : Parodis I , Sjöwall C , Jönsen A , et al. Smoking and pre-existing organ damage reduce the efficacy of Belimumab in systemic lupus erythematosus. Autoimmunity Reviews ; 16 : — Gatto M , Saccon F , Zen M , et al. Early disease and low baseline damage as predictors of response to Belimumab in patients with systemic lupus erythematosus in a real-life setting. Arthritis Rheumatol ; 72 : — Parodis I , Gomez A , Frodlund M , et al. Smoking reduces the efficacy of belimumab in mucocutaneous lupus. Expert Opinion on Biological Therapy ; 18 : — Harrison BJ , Silman AJ , Hider SL , et al. Cigarette smoking as a significant risk factor for digital vascular disease in patients with systemic sclerosis. Arthritis Rheum ; 46 : — 6. Jaeger VK , Valentini G , Hachulla E , et al. Brief report: smoking in systemic sclerosis: a longitudinal European scleroderma trials and research group study. Arthritis Rheumatol ; 70 : — Cigarette smoking in patients with systemic sclerosis. Arthritis Rheum ; 63 : — 8. Modeling smoking in systemic sclerosis: a comparison of different statistical approaches. Arthritis Care Res ; 63 : — 8. Bassel M , Hudson M , Taillefer SS , et al. Frequency and impact of symptoms experienced by patients with systemic sclerosis: results from a Canadian national survey. Rheumatology Oxford ; 50 : — 7. Malcus Johnsson P , Sandqvist G , Nilsson J-Å , et al. Hand function and performance of daily activities in systemic lupus erythematosus: a clinical study. Lupus ; 24 : — Pauling JD , Domsic RT , Saketkoo LA , et al. Pauling JD , Reilly E , Smith T , et al. Factors influencing Raynaud condition score diary outcomes in systemic sclerosis. J Rheumatol ; 46 : — Wilkinson JD , Leggett SA , Marjanovic EJ , et al. Liem SIE , Hoekstra EM , Bonte-Mineur F , et al. The effect of silver fibre gloves on Raynaud's phenomenon in patients with systemic sclerosis: a double-blind randomized crossover trial. Rheumatology Oxford ; 62 : SI74 — Brignoli E , Frassanito P , Vercesi E , et al. Rehabilitation in systemic sclerosis: proposed personalised rehabilitation programme. G Ital Med Lav Ergon ; 40 : — Sohng KY. Effects of a self-management course for patients with systemic lupus erythematosus. J Adv Nurs ; 42 : — Allen KD , Beauchamp T , Rini C , et al. Pilot study of an internet-based pain coping skills training program for patients with systemic lupus erythematosus. BMC Rheumatol ; 5 : Barbhaiya M , Costenbader KH. Ultraviolet radiation and systemic lupus erythematosus. Lupus ; 23 : — Ahluwalia J , Marsch A. Photosensitivity and photoprotection in patients with lupus erythematosus. Stege H , Budde MA , Grether-Beck S , et al. Evaluation of the capacity of sunscreens to photoprotect lupus erythematosus patients by employing the photoprovocation test. Photodermatol Photoimmunol Photomed ; 16 : — 9. Herzinger T , Plewig G , Röcken M. Use of sunscreens to protect against ultraviolet-induced lupus erythematosus. Arthritis Rheum ; 50 : — 6. Abrahão MI , Gomiero AB , Peccin MS , et al. Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial. Scand J Rheumatol ; 45 : — Gokcen N , Badak SO , Sarpel T , et al. The efficacy of a home-based, self-administered hand exercise program for patients with systemic sclerosis: a randomized controlled, evaluator-blind, clinical trial. J Clin Rheumatol ; 28 : e — 9. Antonioli CM , Bua G , Frigè A , et al. An individualized rehabilitation program in patients with systemic sclerosis may improve quality of life and hand mobility. Kwakkenbos L , Bluyssen SJM , Vonk MC , et al. Addressing patient health care demands in systemic sclerosis: pre-post assessment of a psycho-educational group programme. Clin Exp Rheumatol ; 29 : S60 — 5. Landim SF , Bertolo MB , Marcatto de Abreu MF , et al. The evaluation of a home-based program for hands in patients with systemic sclerosis. J Hand Ther ; 32 : — Pizzo G , Scardina GA , Messina P. Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma. Clin Oral Investig ; 7 : — 8. Pinto ALS , Oliveira NC , Gualano B , et al. Efficacy and safety of concurrent training in systemic sclerosis. J Strength Cond Res ; 25 : — 8. Arthritis Care Res Hoboken ; 63 : — Jongsma K , van Seventer J , Verwoerd A , et al. Recommendations from a James LIND alliance priority setting partnership - a qualitative interview study. Res Involv Engagem ; 6 : Levelink M , Voigt-Barbarowicz M , Brütt AL. Priorities of patients, caregivers and health-care professionals for health research - a systematic review. Health Expect ; 23 : — |
| Stomach ulcer - Treatment - NHS | If this was not reached, the statement was discussed and amended further to next be subjected to a third voting round. If this was not reached, the statement was discarded. The voting process was supported by preformulated motivational texts summarising results of the SLR, including the result of the RoB and level of evidence LoE assessment, the latter based on the Oxford Centre for Evidence-Based Medicine LoE 2 system. Level of agreement LoA with each statement was scored in a pseudonymous manner on a scale from 0 complete disagreement to 10 complete agreement. Results from the LoA scoring are presented in table 1 as mean, SD and range. Recommendations for the non-pharmacological management of SLE and SSc. Additionally, the task force proposed a research agenda based on identified needs box 1 as well as an educational agenda for providers of non-pharmacological management of people with SLE and SSc box 2. Randomised controlled trials of non-pharmacological management of people with SLE and SSc with blinding strategies detailed in the study protocols are encouraged. Studies assessing outcomes of non-pharmacological management over a longer term are needed. Investigation of the efficacy of psychosocial interventions in patients with SSc is required. Investigation of the efficacy of skin and wound management strategies is required, particularly for people with SSc. Further identification of barriers for the implementation of non-pharmacological management of SLE and SSc, as well as means to alleviate those barriers, is warranted. Regular training for providers of non-pharmacological management of SLE and SSc is advised to ensure the best possible quality of services and patient outcomes. Increased awareness and education on how to facilitate and evaluate patient education and self-management for people with SLE and SSc should be reinforced among healthcare professionals. Educational programmes within EULAR and EMEUNET dedicated to the non-pharmacological management of people with SLE and SSc are advocated, both for healthcare providers and patients. This could be done in collaboration with the EULAR School of Rheumatology. EULAR, European Alliance of Associations for Rheumatology; EMEUNET, Emerging EULAR network; SLE, systemic lupus erythematosus; SSc, systemic sclerosis. Twelve recommendations for the non-pharmacological management of people with SLE and SSc were developed based on evidence and expert opinion within the task force, emanating the derivation of four overarching principles, as detailed in table 1. The recommendations were grouped into five generic recommendation statements applicable to people with SLE and people with SSc, four recommendation statements applicable to people with SLE and three recommendation statements applicable to people with SSc. Examples of studies supporting each statement are provided. Physical exercise 42 and psychological interventions 43 were found in meta-analyses of RCTs two and three RCTs, respectively 42 43 LoE: 1 to improve HRQoL in patients with SLE. Furthermore, non-pharmacological management in the form of physical exercise was proven efficacious in improving fatigue in patients with SLE based on two meta-analyses, one of an RCT and a quasi-experimental study LoE: 3 and one of two RCTs and one quasi-experimental study LoE: 1 , 44 45 and psychological interventions were found to improve anxiety in patients with SLE based on a meta-analysis of three RCTs 46 LoE: 1 ; these studies were assessed as robust in RoB assessment. In patients with SSc, improvements in HRQoL were noted after occupational therapy provided for improving upper extremity function in a quasi-experimental study 47 LoE: 4. RCTs encompassing patients with SSc assessed as intermediate in CA found rehabilitative treatment of the hands 48 LoE: 2 and home-based aerobic exercise 49 LoE: 2 to improve HRQoL. RCTs assessed as intermediate in RoB assessment employed patient education as a part of physical exercise programmes. The addition of patient education was efficacious in improving aerobic capacity in an RCT of SLE 50 LoE: 2 and mouth opening as compared with the same physical exercise programme mouth stretching in an RCT of SSc 51 LoE: 2. Qualitative assessments of multidisciplinary patient education programmes 52 LoE: 4 and group education on disease management 53 LoE: 4 found these strategies to be beneficial for patients with SLE in terms of improving HRQoL 52 LoE: 4 as well as for implementing favourable lifestyle changes 53 LoE: 4 ; these studies were assessed as robust. In patients with SSc, internet-based self-management programmes could improve self-efficacy and fatigue 54 LoE: 4 , and patient education as a complement to occupational therapy improved functional abilities over a longer term ie, 24 weeks 55 LoE: 3 ; these two quasi-experimental studies were deemed robust. In the general population, tobacco smoking is an established risk factor for cardiovascular disease, cancer, osteoporosis and chronic obstructive pulmonary disease, among other conditions that constitute relevant comorbidities for patients with SLE and SSc. Moreover, among patients with SLE, smoking has been associated with reduced treatment efficacy. A meta-analysis of 10 observational studies found smoking to be negatively associated with the response of cutaneous SLE to antimalarial therapy OR: 0. In the SSc population, a cross-sectional study of patients found that current smokers were more likely to require intravenous vasodilators OR: 3. Despite the lack of interventional studies specifically assessing the efficacy of smoking cessation strategies in the SLR performed to inform the recommendations, it was consensual among the task force members that smoking cessation should be encouraged and facilitated in smokers with SLE and SSc based on the above evidence and expert opinion. Nevertheless, cost-effectiveness aspects should be accounted for, and there should be awareness that literature is inconsistent regarding the effect of smoking on vascular outcomes. For both diseases, exercise and promotion of physical activity were among the most studied intervention strategies and were found to improve patient outcomes in several studies. Physical exercise was found to be a viable management strategy in improving fatigue in adult patients with SLE based on two meta-analyses, one of one RCT and one quasi-experimental study LoE: 3 and one of two RCTs and one quasi-experimental study LoE: 1 , 44 45 and in improving aerobic capacity, based on one meta-analysis of seven RCTs 44 LoE: 1 ; both studies were deemed as robust in overall CA. In adult patients with SSc, an RCT found improvements in mouth opening after application of an oral exercise programme 23 LoE: 2; CA: intermediate. Physiotherapy was found to improve functional impairment in a quasi-experimental study 70 LoE: 4; CA: robust. An RCT employed patient education and self-management support as parts of a supervised aerobic exercise programme and found the intervention to be efficacious in improving aerobic capacity and mental health as compared with usual care in an RCT of SLE 50 LoE: 2; CA: intermediate. Furthermore, an RCT that investigated web-based patient education and counselling 14 LoE: 3; CA: weak and a quasi-experimental study that examined an educational programme for enhancing self-management in patients with SLE 71 LoE: 3; CA: intermediate found these interventions to be efficacious in improving self-efficacy. A pilot RCT that investigated an internet-based coping skill training programme in patients with SLE revealed benefit in HRQoL 72 LoE: 3; CA: weak , as did a qualitative study of multidisciplinary patient education 52 LoE: 4; CA: robust. Ultraviolet UV radiation is a well-acknowledged triggering factor of cutaneous and systemic lupus flares. Based on this evidence and expert opinion within the task force, people with SLE should avoid direct sun exposure, especially during days with high UV index, use physical barriers such as hats, sunglasses and long-sleeved shirts and pants, and use of broad-spectrum sunscreen; assessment of the need for vitamin D supplements should be done when indicated. In SLRs with meta-analyses that were assessed as robust in overall CA, psychological interventions in the form of cognitive behavioural therapy CBT , group therapy and psychoeducational programmes were shown to be an efficacious management strategy for improving HRQoL in adults with SLE based on a meta-analysis of two RCTs 42 LoE: 2 and a meta-analysis of three RCTs 43 LoE: 1. Counselling, CBT and supported psychotherapy improved anxiety based on a meta-analysis of three RCTs 46 LoE: 1. CBT and psychoeducational self-management support ameliorated depressive symptoms based on a meta-analysis of three RCTs 43 LoE: 1. Counselling and psychoeducational programmes were led by different healthcare providers, including social workers, psychologists, and nurses, whereas psychotherapeutic interventions were delivered by certified psychotherapists. Which healthcare providers deliver different psychoeducational programmes may differ considerably across countries, depending on local legislation as well as access to and use of resources. An SLR with meta-analyses from found that aerobic exercise increased aerobic capacity in patients with SLE based on a meta-analysis of two RCTs and three quasi-experimental studies; LoE: 1 , while decreasing fatigue based on a meta-analysis of one RCT and one quasi-experimental study; LoE: 3 , and depressive symptoms based on a meta-analysis of two RCTs and one quasi-experimental study; LoE: 3 44 and was assessed as robust in CA. Another meta-analysis of two RCTs and one quasi-experimental study assessed as robust in CA found that aerobic physical exercise was effective in managing fatigue in patients with SLE 45 LoE: 1. An RCT found self-administered hand exercises effective in improving hand mobility 78 LoE: 2; CA: intermediate. Another RCT demonstrated the efficacy of face-to-face training in improving the outcomes of orofacial exercise 51 LoE: 2; CA: intermediate. Individualised rehabilitation programmes were found to improve hand mobility and HRQoL 79 LoE: 3 while psychoeducational group programmes ameliorated feelings of helplessness 80 LoE: 4 in quasi-experimental studies of patients with SSc assessed as robust in overall CA. Another robust in CA quasi-experimental study found patient education as a complement to occupational therapy to improve functional abilities as assessed with the Health Assessment Questionnaire HAQ and the Evaluation of Daily Activity Questionnaire EDAQ 55 LoE: 3. A home-based self-management programme for hand exercise was found to improve hand function in a quasi-experimental study 81 that was also deemed as robust in CA LoE: 4. Microstomia and hand function emerged as major targets of non-pharmacological management, especially in studies evaluating physical exercise. RCTs assessed as intermediate in CA found mouth exercise to be efficacious in improving microstomia 23 LoE: 2 and hand exercise in improving hand function 78 LoE: 2 , while body exercise increased the 6MWD 49 LoE: 2. The favourable effects of rehabilitation programmes were discussed. Quasi-experimental studies assessed as robust in CA found that rehabilitative exercise programmes were efficacious in improving hand function and HRQoL, for example, programmes comprising warm-up and cool-down exercises, training of motor functions and respiratory exercises 79 LoE: 3 , mouth stretching and oral augmentation exercises ameliorated microstomia 82 LoE: 4 , thermal modalities eg, baths , tissue mobilisation and hand mobility exercises improved hand function 47 LoE: 4 and combined resistance and aerobic exercise enhanced aerobic capacity 83 LoE: 4 in patients with SSc. Improvements were also noted in HAQ and item Short Form health survey scores at the end of treatment, although these improvements were not fully sustained at the 9-week follow-up. The findings from this study and expert opinion within the task force supported the endorsement of this recommendation statement. Box 1 details the research agenda proposed by the task force. This was based on areas of limited or weak evidence as well as identified needs. The overarching principles should be applied when addressing the proposed research topics. In brief, while the SLR identified, several RCTs dealing with the non-pharmacological management of SLE and SSc, design details were not always clearly indicated, especially the blinding strategies, which limited their LoE. Hence, studies assessing outcomes of non-pharmacological management over a longer term are needed. While the efficacy of diverse psychological interventions was investigated in several studies encompassing people with SLE, it has yet to be explored within SSc. Dietary therapy was not thoroughly explored in either of the two diseases. Adherence to a Mediterranean diet was associated with a lower cardiovascular risk, lower disease activity levels and protection against organ damage in a cross-sectional study of SLE assessed as robust in CL 36 LoE: 3 , but no conclusions regarding causality can be drawn from this study. Moreover, recommendations about wound management could not be derived based on current evidence, indicating a need for further studies within this area, which is particularly important for patients with SSc. Finally, further identification of barriers for the implementation of non-pharmacological management of SLE and SSc, as well as means to alleviate those barriers, is warranted. Box 2 details the educational agenda proposed by the task force for providers of non-pharmacological management of people with SLE and SSc. Increasing awareness of the importance of non-pharmacological management and self-management strategies for people living with SLE and SSc necessitated the development of overarching principles and recommendations by a group of experts, to be used as a guide in the identification of needs, implementation and evaluation of non-pharmacological management. Hence, a multidisciplinary EULAR task force convened and formulated the overarching principles and recommendations presented herein following the EULAR SOPs. Along with recommendations regarding lifestyle behaviours 87 as well as recommendations for physical activity, 88 patient education 89 and implementation of self-management strategies in inflammatory arthritis, 90 the statements presented herein intend to not only guide non-pharmacological management but also increase awareness of the importance of patient involvement in the management of their disease, encourage interprofessional and multidisciplinary teams to tackle clinical challenges and prompt orchestrated research for addressing remaining important questions that form a research agenda, as determined by the task force. The heterogeneity in study design and conduct limited the LoE and strength of recommendation in several instances. Data in the literature were scarce even for well-established non-pharmacological strategies such as photoprotection for patients with SLE, which is not surprising considering the known contribution of sun exposure to disease precipitation, imposing ethical limitations for the conduct of RCTs on such interventions. The same could be argued for the contribution of assistive devices to enhancing mobility or improving accessibility, which is rather self-evident. Nonetheless, the rarity of SLE and SSc necessitates global collaborative efforts in the design of studies, especially investigator-initiated endeavours that deserve better funding. Moderate to strong evidence existed in the literature for the benefits of physical activity and exercise for SLE and SSc patients, including documented benefits regarding HRQoL, fatigue and cardiovascular burden. The task force also agreed that cost-effectiveness aspects should be accounted for; to illustrate why, proper modelling of the effect of smoking has been shown to be essential in studies of vascular outcomes within rheumatic diseases, SSc in particular, resulting in rather insipid evidence. It is important to underscore that concomitant conditions such as fibromyalgia or other syndromes causing chronic pain, as well as established irreversible organ damage, pose challenges when evaluating the effectiveness of non-pharmacological management. Together with the complexity of SLE and SSc in terms of heterogeneity of disease manifestations, the multidimensionality of non-pharmacological interventions and sparsity of high-quality data and RCTs, especially RCTs meeting their predetermined endpoints, is not unexpected. These factors also form incentives for large-scale collaborative efforts to determine patient needs and priorities, identify barriers and means for overcoming them and investigate the efficacy of psychosocial interventions, different dietary schemes and skin and wound management. Also, efforts should be applied in educating healthcare professionals and patients on the potentiality of different non-pharmacological strategies, which in turn is expected to facilitate person-centredness in non-pharmacological management, accounting for the heterogeneity of SLE and SSc. This will provide an important mapping of the current practice patterns and highlight needs for the implementation. Further steps will include determination of implementation strategies at a centre, national or international levels such as educational activities designed for patients and for healthcare professionals, and evaluation of the implementation. In summary, results from an SLR, RoB assessment and expert opinion within the task force resulted in the formulation of overarching principles and a comprehensive set of recommendations for the non-pharmacological management of people living with SLE and SSc. The overarching principles and recommendations presented herein promote holistic and multidisciplinary approaches in SLE and SSc patient management, patient involvement in their care and individually tailored strategies towards optimised outcomes. Despite a sparsity in high-quality evidence, the recommendations presented herein may be seen as a useful guide for healthcare providers and patients with SLE and SSc when setting up individual disease management strategies, with non-pharmacological constituents as integral components. Last but not least, the task force developed a research agenda to guide future endeavours in the field. The task force expresses gratitude to Alvaro Gomez, Alexander Tsoi, Jun Weng Chow and Denise Pezzella for contributions to the SLR performed to inform the recommendations, as well as the EULAR Secretariat for assistance during the entire process. We would also like to thank Emma-Lotta Säätelä, librarian at the KI Library, for her help with the search strategy for the SLRs. Contributors IP wrote the first draft of the manuscript with help and guidance from CG-G, TAS and CB. All authors participated in the work of the task force, including the formulation of the overarching principles and recommendation statements, as well as read and approved the final manuscript. The convenor CB is responsible for the overall content as guarantor, controlled the decision to publish, and accepts full responsibility for the finished work and conduct of the project. Funding This project was funded by the European Alliance of Associations for Rheumatology EULAR [ref. MN reports research grants from BMS, Vifor Pharma and Sanofi paid to his institution, speaking fees from CCIS The Conference Company and Eli Lilly, all outside the submitted work. JEV reports speaker fees from Eli Lilly, and Galapagos. RW has received honoraria from Galapagos, Celltrion, Gilead Sciences, and Union Chimique Belge UCB. The other authors declare that they have no conflicts of interest. Provenance and peer review Not commissioned; externally peer reviewed. Skip to main content. Subscribe Log In More Log in via Institution. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Advanced search. Latest content Current issue Archive Authors About Podcasts. Close More Main menu Latest content Current issue Archive Authors About Podcasts. Log in via Institution. You are here Home Online First EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Email alerts. Article Text. Article menu. Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts. EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Abstract Objective To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus SLE and systemic sclerosis SSc. Statistics from Altmetric. Systemic Lupus Erythematosus Systemic Sclerosis Patient perspective Patient Reported Outcome Measures Patient Care Team. Video Abstract Disclaimer: this video summarises a scientific article published by BMJ Publishing Group Limited BMJ. What is already known about this subject? What does this study add? How might this impact on clinical practice? Introduction Systemic lupus erythematosus SLE is a chronic, inflammatory, autoimmune disease that predominantly affects women and is characterised by multisystem involvement. Methods Steering committee and task force Following the EULAR standard operating procedure SOP for the development of EULAR-endorsed recommendations, 6 the convener CB; physiotherapist formed the steering committee and task force. Target audience In compliance with the update of EULAR SOP for the development of EULAR-endorsed recommendations, 6 the main target audience of the recommendations presented herein is healthcare providers health professionals in rheumatology and physicians as well as people living with SLE or SSc. Definitions On proposals by the steering committee, the task force agreed on definitions and uniform nomenclature concerning non-pharmacological management and its goals as well as the patient population for a subsequent systematic literature review SLR. Research questions and SLR The task force formulated nine research questions to be addressed during the SLRs and that should steer the development of the recommendation statements. Formulation of overarching principles and recommendation statements Based on the results from the SLR and mainly driven by the overall CA, but also expert opinion, overarching principles and recommendation statements were proposed by the steering committee and were presented and discussed with the task force members at four consecutive online meetings in May and June View this table: View inline View popup. Table 1 Recommendations for the non-pharmacological management of SLE and SSc. Box 1 Research agenda Randomised controlled trials of non-pharmacological management of people with SLE and SSc with blinding strategies detailed in the study protocols are encouraged. Investigation of the efficacy of different dietary programmes is encouraged. SLE, systemic lupus erythematosus; SSc, systemic sclerosis. Box 2 Educational agenda for providers of non-pharmacological management of SLE and SSc Regular training for providers of non-pharmacological management of SLE and SSc is advised to ensure the best possible quality of services and patient outcomes. Results Twelve recommendations for the non-pharmacological management of people with SLE and SSc were developed based on evidence and expert opinion within the task force, emanating the derivation of four overarching principles, as detailed in table 1. Recommendations for the non-pharmacological management of SLE and SSc Non-pharmacological management should be directed towards improving HRQoL in people with SLE LoE: 1—3 and SSc LoE: 2—4 Physical exercise 42 and psychological interventions 43 were found in meta-analyses of RCTs two and three RCTs, respectively 42 43 LoE: 1 to improve HRQoL in patients with SLE. People with SLE and SSc should be offered patient education and self-management support LoE: 2—4 RCTs assessed as intermediate in RoB assessment employed patient education as a part of physical exercise programmes. In people with SLE LoE: 3 and SSc LoE: 4 , smoking habits should be assessed, and cessation strategies should be implemented In the general population, tobacco smoking is an established risk factor for cardiovascular disease, cancer, osteoporosis and chronic obstructive pulmonary disease, among other conditions that constitute relevant comorbidities for patients with SLE and SSc. Physical exercise should be considered for people with SLE LoE: 1—3 and SSc LoE: 2—4 For both diseases, exercise and promotion of physical activity were among the most studied intervention strategies and were found to improve patient outcomes in several studies. Recommendations for the non-pharmacological management of SLE In people with SLE, patient education and self-management support should be considered for improving physical exercise outcomes LoE: 2 and HRQoL LoE: 2—4 and could be considered for enhancing self-efficacy LoE: 3 An RCT employed patient education and self-management support as parts of a supervised aerobic exercise programme and found the intervention to be efficacious in improving aerobic capacity and mental health as compared with usual care in an RCT of SLE 50 LoE: 2; CA: intermediate. In people with SLE, photoprotection should be advised for the prevention of flares LoE: 4 Ultraviolet UV radiation is a well-acknowledged triggering factor of cutaneous and systemic lupus flares. In people with SLE, psychosocial interventions should be considered for improving HRQoL LoE: 1—2 , anxiety LoE: 1 and depressive symptoms LoE: 1 In SLRs with meta-analyses that were assessed as robust in overall CA, psychological interventions in the form of cognitive behavioural therapy CBT , group therapy and psychoeducational programmes were shown to be an efficacious management strategy for improving HRQoL in adults with SLE based on a meta-analysis of two RCTs 42 LoE: 2 and a meta-analysis of three RCTs 43 LoE: 1. In people with SLE, aerobic exercise should be considered for increasing aerobic capacity LoE: 1 and for reducing fatigue LoE: 1—3 and depressive symptoms LoE: 3 An SLR with meta-analyses from found that aerobic exercise increased aerobic capacity in patients with SLE based on a meta-analysis of two RCTs and three quasi-experimental studies; LoE: 1 , while decreasing fatigue based on a meta-analysis of one RCT and one quasi-experimental study; LoE: 3 , and depressive symptoms based on a meta-analysis of two RCTs and one quasi-experimental study; LoE: 3 44 and was assessed as robust in CA. Recommendations for the non-pharmacological management of SSc In people with SSc, patient education and self-management support should be considered for improving hand function LoE: 2—4 , mouth-related outcomes LoE: 2 , HRQoL LoE: 2—4 and ability to perform daily activities LoE: 2—3 An RCT found self-administered hand exercises effective in improving hand mobility 78 LoE: 2; CA: intermediate. In people with SSc, orofacial, hand and aerobic and resistance exercise should be considered for improving microstomia LoE: 2—4 , hand function LoE: 2—4 and physical capacity LoE: 2—4 , respectively Microstomia and hand function emerged as major targets of non-pharmacological management, especially in studies evaluating physical exercise. Research agenda Box 1 details the research agenda proposed by the task force. Educational agenda for providers of non-pharmacological management of SLE and SSc Box 2 details the educational agenda proposed by the task force for providers of non-pharmacological management of people with SLE and SSc. Discussion Increasing awareness of the importance of non-pharmacological management and self-management strategies for people living with SLE and SSc necessitated the development of overarching principles and recommendations by a group of experts, to be used as a guide in the identification of needs, implementation and evaluation of non-pharmacological management. Ethics statements Patient consent for publication Not applicable. Ethics approval Not applicable. Acknowledgments The task force expresses gratitude to Alvaro Gomez, Alexander Tsoi, Jun Weng Chow and Denise Pezzella for contributions to the SLR performed to inform the recommendations, as well as the EULAR Secretariat for assistance during the entire process. Systemic lupus erythematosus. Nat Rev Dis Primers ; 2 : Anders HJ , Saxena R , Zhao MH , et al. Lupus nephritis. Nat Rev Dis Primers ; 6 : 7. Gomez A , Qiu V , Cederlund A , et al. Adverse health-related quality of life outcome despite adequate clinical response to treatment in systemic lupus erythematosus. Front Med Lausanne ; 8 : Denton CP , Khanna D. Systemic sclerosis. Lancet ; : — OpenUrl CrossRef PubMed. Stöcker JK , Schouffoer AA , Spierings J , et al. Rheumatology ; 61 : — van der Heijde D , Aletaha D , Carmona L , et al. Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Sometimes you may be given additional medication called antacids to relieve your symptoms in the short term. You may have a repeat gastroscopy after 4 to 6 weeks to check that the ulcer has healed. There aren't any special lifestyle measures you need to take during treatment, but avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals. If you have an H. pylori infection, you'll usually be prescribed a course of 2 antibiotics, which each need to be taken twice a day for a week. The antibiotics most commonly used are amoxicillin, clarithromycin and metronidazole. You'll be tested at least 4 weeks after finishing your antibiotic course to see if there are any H. pylori bacteria left in your stomach. If there are, you may need a course of different antibiotics. PPIs work by reducing the amount of acid your stomach produces, preventing further damage to the ulcer as it heals naturally. They're usually prescribed for 4 to 8 weeks. Omeprazole , pantoprazole and lansoprazole are the PPIs most commonly used to treat stomach ulcers. Like PPIs, H2-receptor antagonists work by reducing the amount of acid your stomach produces. H2-receptor antagonists, such as famotidine, are often used to treat stomach ulcers. Treatments can take several hours before they start to work, so your GP may recommend taking additional antacid medication to neutralise your stomach acid quickly and relieve symptoms in the short term. Current topics in microbiology and immunology, Gastroduodenal disease and Helicobacter pylori: pathophysiology, diagnosis and treatment. Berlin Heidelberg: Springer ; Kundu P , Mukhopadhyay AK, Patra R, Banerjee A, Berg DE, Swarnakar S. Cag pathogenicity island-independent up-regulation of matrix metalloproteinases-9 and -2 secretion and expression in mice by Helicobacter pylori infection. J Biol Chem. Graham DY. Efficient identification and evaluation of effective Helicobacter pylori therapies. Clin Gastroenterol Hepatol. Mégraud F , Lehours P. Helicobacter pylori detection and antimicrobial susceptibility testing. Clin Microbiol Rev. Peterson WL , Graham DY, Marshall B, Blaser MJ, Genta RM, Klein PD, Stratton CW, Drnec J, Prokocimer P, Siepman N. Clarithromycin as monotherapy for eradication of Helicobacter pylori: a randomized, double-blind trial. Am J Gastroenterol. Calvet X , Gisbert JP, Suarez D. Key points for designing and reporting Helicobacter pylori therapeutic trials: a personal view. Howell AB. Cranberry proanthocyanidins and the maintenance of urinary tract health. Crit Rev Food Sci Nutr. Burger O , Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol. Parente F , Cucino C, Anderloni A, Grandinetti G, Bianchi Porro G. A double blind, placebo-controlled clinical study. Ilver D , Arnqvist A, Ogren J, Frick IM, Kersulyte D, Incecik ET, Berg DE, Covacci A, Engstrand L, Borén T. Helicobacter pylori adhesin binding fucosylated histo-blood group antigens revealed by retagging. Guruge JL , Falk PG, Lorenz RG, Dans M, Wirth HP, Blaser MJ, Berg DE, Gordon JI. Epithelial attachment alters the outcome of Helicobacter pylori infection. Proc Natl Acad Sci USA. Xiao SD , Shi T. Is cranberry juice effective in the treatment and prevention of Helicobacter pylori infection in mice? Chinese J Dig Dis. Shmuely H , Ofek I, Weiss EI, Rones Z, Houri-Haddad Y. Cranberry components for the therapy of infectious disease. Curr Opin Biotechnol. Côté J , Caillet S, Doyon G, Sylvain JF, Lacroix M. Bioactive compounds in cranberries and their biological properties. Matsushima M , Suzuki T, Masui A, Kasai K, Kouchi T, Takagi A, Shirai T, Mine T. Growth inhibitory action of cranberry on Helicobacter pylori. J Gastroenterol Hepatol. Gotteland M , Andrews M, Toledo M, Muñoz L, Caceres P, Anziani A, Wittig E, Speisky H, Salazar G. Modulation of Helicobacter pylori colonization with cranberry juice and Lactobacillus johnsonii La1 in children. Lin YT , Kwon YI, Labbe RG, Shetty K. Inhibition of Helicobacter pylori and associated urease by oregano and cranberry phytochemical synergies. Appl Environ Microbiol. Burger O , Weiss E, Sharon N, Tabak M, Neeman I, Ofek I. Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. Zafra-Stone S , Yasmin T, Bagchi M, Chatterjee A, Vinson JA, Bagchi D. Berry anthocyanins as novel antioxidants in human health and disease prevention. Mol Nutr Food Res. Chatterjee A , Yasmin T, Bagchi D, Stohs SJ. Inhibition of Helicobacter pylori in vitro by various berry extracts, with enhanced susceptibility to clarithromycin. Mol Cell Biochem. Shmuely H , Burger O, Neeman I, Yahav J, Samra Z, Niv Y, Sharon N, Weiss E, Athamna A, Tabak M. Susceptibility of Helicobacter pylori isolates to the antiadhesion activity of a high-molecular-weight constituent of cranberry. Diagn Microbiol Infect Dis. Zhang L , Ma J, Pan K, Go VL, Chen J, You WC. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Shmuely H , Yahav J, Samra Z, Chodick G, Koren R, Niv Y, Ofek I. Effect of cranberry juice on eradication of Helicobacter pylori in patients treated with antibiotics and a proton pump inhibitor. Farbman KS , Barnett ED, Bolduc GR, Klein JO. Antibacterial activity of garlic and onions: a historical perspective. Pediatr Infect Dis J. Cañizares P , Gracia I, Gómez LA, Martín de Argila C, de Rafael L, García A. Optimization of Allium sativum solvent extraction for the inhibition of in vitro growth of Helicobacter pylori. Biotechnol Prog. Lawson LD , Wang ZJ, Papadimitriou D. Allicin release under simulated gastrointestinal conditions from garlic powder tablets employed in clinical trials on serum cholesterol. Planta Med. Cañizares P , Gracia I, Gómez LA, García A, Martín De Argila C, Boixeda D, de Rafael L. Thermal degradation of allicin in garlic extracts and its implication on the inhibition of the in-vitro growth of Helicobacter pylori. Dorant E , van den Brandt PA, Goldbohm RA, Sturmans F. Consumption of onions and a reduced risk of stomach carcinoma. You WC , Brown LM, Zhang L, Li JY, Jin ML, Chang YS, Ma JL, Pan KF, Liu WD, Hu Y. Randomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions. J Natl Cancer Inst. Tang HR , Fan YJ, Liu S. Helicobacter pylori infection and associated risk factors in Chengdu. Sichuan Daxue Xuebao Yixueban. Salih BA , Abasiyanik FM. Does regular garlic intake affect the prevalence of Helicobacter pylori in asymptomatic subjects? Saudi Med J. A pilot study to determine the effectiveness of garlic oil capsules in the treatment of dyspeptic patients with Helicobacter pylori. Aydin A , Ersöz G, Tekesin O, Akçiçek E, Tuncyurek M, Batur Y. Does garlic oil have a role in the treatment of Helicobacter pylori infection? Turk Gastroenteroloji Dergisi. Sharma RA , Gescher AJ, Steward WP. Curcumin: the story so far. Eur J Cancer. Egan ME , Pearson M, Weiner SA, Rajendran V, Rubin D, Glöckner-Pagel J, Canny S, Du K, Lukacs GL, Caplan MJ. Curcumin, a major constituent of turmeric, corrects cystic fibrosis defects. Bengmark S. Curcumin, an atoxic antioxidant and natural NFkappaB, cyclooxygenase-2, lipooxygenase, and inducible nitric oxide synthase inhibitor: a shield against acute and chronic diseases. JPEN J Parenter Enteral Nutr. Punithavathi D , Venkatesan N, Babu M. Protective effects of curcumin against amiodarone-induced pulmonary fibrosis in rats. Br J Pharmacol. Ringman JM , Frautschy SA, Cole GM, Masterman DL, Cummings JL. Curr Alzheimer Res. Duvoix A , Blasius R, Delhalle S, Schnekenburger M, Morceau F, Henry E, Dicato M, Diederich M. Chemopreventive and therapeutic effects of curcumin. Cancer Lett. Holt PR , Katz S, Kirshoff R. Curcumin therapy in inflammatory bowel disease: a pilot study. Dig Dis Sci. Swarnakar S , Ganguly K, Kundu P, Banerjee A, Maity P, Sharma AV. Curcumin regulates expression and activity of matrix metalloproteinases 9 and 2 during prevention and healing of indomethacin-induced gastric ulcer. Foryst-Ludwig A , Neumann M, Schneider-Brachert W, Naumann M. Curcumin blocks NF-kappaB and the motogenic response in Helicobacter pylori-infected epithelial cells. Biochem Biophys Res Commun. Santos AM , Lopes T, Oleastro M, Gato IV, Floch P, Benejat L, Chaves P, Pereira T, Seixas E, Machado J. Curcumin inhibits gastric inflammation induced by Helicobacter pylori infection in a mouse model. Kundu P , De R, Pal I, Mukhopadhyay AK, Saha DR, Swarnakar S. Curcumin alleviates matrix metalloproteinase-3 and -9 activities during eradication of Helicobacter pylori infection in cultured cells and mice. PLoS One. Han C , Wang L, Yu K, Chen L, Hu L, Chen K, Jiang H, Shen X. Biochemical characterization and inhibitor discovery of shikimate dehydrogenase from Helicobacter pylori. FEBS J. Cheng WC , Chen YF, Wang HJ, Hsu KC, Lin SC, Chen TJ, Yang JM, Wang WC. Structures of Helicobacter pylori shikimate kinase reveal a selective inhibitor-induced-fit mechanism. Coggins JR , Abell C, Evans LB, Frederickson M, Robinson DA, Roszak AW, Lapthorn AP. Experiences with the shikimate-pathway enzymes as targets for rational drug design. Biochem Soc Trans. Koosirirat C , Linpisarn S, Changsom D, Chawansuntati K, Wipasa J. Investigation of the anti-inflammatory effect of Curcuma longa in Helicobacter pylori-infected patients. Int Immunopharmacol. Prucksunand C , Indrasukhsri B, Leethochawalit M, Hungspreugs K. Phase II clinical trial on effect of the long turmeric Curcuma longa Linn on healing of peptic ulcer. Southeast Asian J Trop Med Public Health. Farnsworth RF , Fong HHS, Mahady GB. WHO monographs on selected medicinal plants. Geneva, Switzerland: WHO Publications ;. Yoshikawa M , Yamaguchi S, Kunimi K, Matsuda H, Okuno Y, Yamahara J, Murakami N. Stomachic principles in ginger. An anti-ulcer principle, 6-gingesulfonic acid, and three monoacyldigalactosylglycerols, gingerglycolipids A, B, and C, from Zingiberis Rhizoma originating in Taiwan. Chem Pharm Bull Tokyo. Kim EC , Min JK, Kim TY, Lee SJ, Yang HO, Han S, Kim YM, Kwon YG. al-Yahya MA , Rafatullah S, Mossa JS, Ageel AM, Parmar NS, Tariq M. Gastroprotective activity of ginger zingiber officinale rosc. Am J Chin Med. Siddaraju MN , Dharmesh SM. Li L , Li L, Zhou X, Xiao S, Gu H, Zhang G. Helicobacter pylori Infection Is Associated with an Increased Risk of Hyperemesis Gravidarum: A Meta-Analysis. Gastroenterol Res Pract. Karaca C , Güler N, Yazar A, Camlica H, Demir K, Yildirim G. Is lower socio-economic status a risk factor for Helicobacter pylori infection in pregnant women with hyperemesis gravidarum? Turk J Gastroenterol. Mahady GB , Pendland SL, Yun GS, Lu ZZ, Stoia A. Anticancer Res. El Younis CM , Abulafia O, Sherer DM. Rapid marked response of severe hyperemesis gravidarum to oral erythromycin. Am J Perinatol. Ishiguro K , Ando T, Maeda O, Ohmiya N, Niwa Y, Kadomatsu K, Goto H. Ginger ingredients reduce viability of gastric cancer cells via distinct mechanisms. Gaus K , Huang Y, Israel DA, Pendland SL, Adeniyi BA, Mahady GB. Standardized ginger Zingiber officinale extract reduces bacterial load and suppresses acute and chronic inflammation in Mongolian gerbils infected with cagAHelicobacter pylori. Pharm Biol. Al-Habbal MJ , Al-Habbal Z, Huwez FU. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Clin Exp Pharmacol Physiol. Aebischer T , Meyer TF, Andersen LP. |
Gut topic
Darin ist etwas.
Ihre Phrase ist unvergleichlich...:)