Page last updated: Wednesday, November 19, 2008
GASTRITIS, ULCER, STOMACH CANCER – MIGHT DRINKING BE PROTECTIVE?
by Harvey Finkel, M.D
Upper gastronintestinal diseases, particularly gastritis, ulcer, and cancer, have often and long been blamed on drinking alcohol. For acute gastritis, inflammation of the stomach lining, this is an accepted truth for those who drink large quantities quickly (binge drinking) of high-strength potables, spirits. Chronic gastritis may have an entirely different cause, as we shall see. Chronic alcohol abuse increases the risks of esophageal and, perhaps, stomach cancer.

Most of us are more interested in the effects of moderate drinking on the risks of getting various diseases, and we have become aware that risks are often reduced thereby. It is surprising, however, to come across evidence that moderate consumption of wine may reduce the risks of upper gastrointestinal inflammation, ulceration, and even cancer, apparently by combating infection. One more surprise will complete the setting, one that virtually no one in the medical profession had suspected; much of gastritits, the large majority of peptic ulcers, and a substantial proportion of cancers of the stomach, both the more common and especially deadly carcinomas and the far less common lymphomas, are caused by chronic infection by the bacterium Helicobacter pylori (H pylori).

Let us consider the credentials of alcohol as an anti-infective agent. Although abuse may impair immunity, moderate consumption of alcohol, particularly as wine, may help protect against infection, supported first by lore, then by observation, finally by science. The first notation of a J-shaped curve reported that moderate drinking appeared to offer protection against tuberculosis. Drinking has been shown by controlled experiment to reduce susceptibility to the common cold.

It is in the gastrointestinal tract that wine is most salubrious in protection from infections, largely, in the tropics, as substitute for contaminated water carrying the agents of infectious diarrheas. Claret was drunk in British army messes in India as "sovereign preventative against the prevalent cholera". Alois Pick demonstrated in Paris a century ago during a raging cholera epidemic that diluted wine killed the offending bacteria in 15 minutes. Wine and spirits (not beer) were reported to protect against hepatitis carried by raw oysters.Undiluted wine proved superior to other solutions, including alcohol, tequila, and is a widely used diarrheal remedy in quickly reducing the bacterial counts of Escherichia coli, Salmonella typhimurium, and Shigella sonnei, causes of "traveller’s diarrhea," typhoid-like disease, and bacillary dysentery.The researchers believed that the antibacterial agent in wine is a polyphenol liberated during fermentation, that it is most active in the acid conditions found in the stomach, and that the antimicrobial properties increase with the age of the wine, peaking at about ten years, then falling off gradually. We should recall that some polyphenols function in the vine to protect it from infection.

Getting back to our villain, H Pylori,, we find increasing evidence that this bacterium, not alcohol, causes the chronic gastritis that distresses so many, especially alcoholics. In a study of alcoholic patients with dyspepsia due to chronic gastritis, neither abstinence (in the hospital) nor anti-acids relieved the condition, but antibacterial treatment to eliminate H pylori led to significant improvement.

Uninfected alcoholics are not unduly susceptible to gastritis. Alcoholics are more likely than average to be infected with H pylori, probably more because of their background and lifestyle than the alcohol abuse directly. Many millions are infected with this bacterium, more likely amidst crowded and imperfectly sanitary conditions. It is believed that most infections begin during childhood, and persist until treated. H pylori can grow and multiply in water and soft drinks, and spread from one person to another easily, especially in families, by, say, the sharing of drink containers.

Among adults living in decent conditions, however, moderate or higher consumption of alcohol has recently been reported as protective against H pylori, more likely by eliminating infection than by preventing it. (Coffee is associated with increased risk of infection) There is a glimmer of suspicion about H pylori’s role in cardiovascular disease. While we know that wine may aggravate heartburn, a very large study has shown no increase of risk of duodenal ulcer associated with alcohol, coffee, or even smoking. It is now believed that the vast majority of ulcers are caused by H pylori.

What of cancer? Frank and prolonged abuse of alcohol increases risk of certain upper gastrointestinal cancers, particularly when combined with smoking. H pylori is a cause of gastric cancers, so moderation of consumption and abstinence from smoking should reduce this cancer risk. Now we are presented evidence that the risk of carcinomas of the upper stomach and lower esophagus is decreased by drinking wine. (Beer and spirits, however, offer no such help.) Hundreds of residents of Connecticut, New Jersey, and Washington state were studied, along with suitable controls. Those who had only drunk wine had only 60 percent as much risk of developing adenocarcinoma of the esophagus or upper stomach (cardia) as those who had not. Another type of cancer of the esophagus, squamous cell carcinoma, was also at the same reduced risk in wine drinkers, but a considerably higher risk for beer drinkers (double abstainers’) and liquor drinkers (triple).Even after adjusting for other variables, the investigators found increasing levels of education and income associated with reduced cancer risk. The mechanism of risk reduction, via H pylori elimination or others, is unknown.

Shall we get our take-home lesson from Paul? Drink no longer water, but use a little wine for thy stomach’s sake and thine often infirmities.–I Timothy 5:23

Dr. Harvey E. Finkel is clinical professor of medicine at the Boston University Medical Center, and chairman of the Committee on Health of the Society of Wine Educators. He writes regularly on the inter-relationships of alcohol and health.

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