Deglycyrrhizinated licorice (DGL)

In functional dyspepsia DGL was studied in one larger RCT. Raveendra (2012) tested GutGard (a standardized licorice root extract) in 50 patients with functional dyspepsia: 30 days of 150 mg/day improved the overall symptom score versus placebo. This is a small sample, single center, short follow-up. EMA HMPC 2012 recognizes only traditional use of licorice root for dyspepsia. No Cochrane review of DGL in functional dyspepsia exists. Rome IV 2016 and ACG 2017 frame functional dyspepsia as a diagnosis of exclusion after H. pylori testing (Maastricht VI 2022, AEG 2022) and alarm-symptom assessment; therapy includes H. pylori test-and-treat, empirical PPI for 4-8 weeks, prokinetic for post-prandial distress and low-dose TCA or SSRI if needed. DGL is not mentioned in the guidelines. If DGL is considered as an add-on to PPI or prokinetic, discuss with a gastroenterologist – mild cytoprotection is plausible but not first-line therapy.

DGL is an over-the-counter botanical supplement. In peptic ulcer disease the evidence base is limited to small old RCTs. Morgan (Gut 1985) compared Caved-S (DGL plus antacids) with cimetidine in 169 patients over 2 years: gastric ulcer recurrence rates were comparable. Tewari (Practitioner 1989) in 874 duodenal ulcer patients compared DGL with cimetidine: efficacy was similar. These trials predate the H. pylori eradication era and proton pump inhibitors and do not translate to modern care. NICE CG184 and ACG 2017 recommend a 4-8 week PPI course in peptic ulcer disease plus mandatory H. pylori testing and eradication per Maastricht VI 2022. AEMPS and AESAN classify DGL as a complemento alimenticio without therapeutic indication. No Cochrane review on DGL in peptic ulcer exists. DGL may be a mild adjunct alongside core therapy but is NOT a replacement for PPIs and eradication – ulcers do not heal durably without acid suppression and H. pylori removal. If DGL was bought «instead of omeprazole», discuss the treatment plan with a gastroenterologist – the DGL evidence base in ulcer disease is weak and outdated.

DGL is marketed as a «natural alternative to antibiotics for H. pylori». It is not a replacement for eradication therapy. Small in vitro and pilot studies show mild antimicrobial action of licorice flavonoids against H. pylori, but DGL has no clinical RCTs with H. pylori eradication as an endpoint. Maastricht VI 2022 and the Spanish AEG/SEPD 2022 consensus place quadruple bismuth therapy first-line (omeprazole + bismuth + tetracycline + metronidazole for 10-14 days) or clarithromycin-based therapy in low-resistance regions; eradication without antibiotics is not achieved at current evidence levels. The Cochrane systematic review by Wang (2016) on adjuvant herbal preparations in H. pylori shows that some herbs improve adherence and tolerance but do not replace antibiotics. If DGL was bought «instead of quadruple therapy for H. pylori», discuss the treatment plan with a gastroenterologist – untreated H. pylori infection leads to atrophic gastritis, ulcer disease and raised gastric cancer risk.