Mastic gum

Mastic gum is an over-the-counter botanical supplement with traditional use for mild dyspepsia. EMA HMPC 2015 included Pistacia lentiscus in a community herbal monograph as a traditional use product for symptomatic relief of mild dyspepsia and superficial skin inflammation. A small RCT by Kottakis (J Ethnopharmacol 2008) in 60 patients with dyspepsia showed an improved symptom score after 4 weeks of 350 mg mastic three times daily. The sample is small with no PPI comparison. Per Rome IV 2016 and ACG 2017 functional dyspepsia is a diagnosis of exclusion after H. pylori testing and alarm symptom assessment; standard care is H. pylori test-and-treat (Maastricht VI 2022), empirical PPI for 4-8 weeks and a prokinetic in post-prandial distress. Mastic is not mentioned as an option in the guidelines. If mastic is considered as a mild adjunct alongside a PPI, discuss with a gastroenterologist – it is well tolerated but does not stand in for standard therapy.

Mastic gum in H. pylori is not a replacement for standard eradication therapy but a possible mild adjunct. A small RCT by Dabos (Phytomedicine 2010) in 52 patients with H. pylori without ulcer compared mastic 350 mg three times daily for 14 days with pantoprazole and triple therapy: mastic monotherapy eradicated H. pylori in about 30-35% versus 77% in the triple therapy arm. This is well below the standard. 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; the target eradication rate is above 90%. In Spain Maastricht VI 2022 recommends quadruple bismuth first-line because of high clarithromycin resistance. The Cochrane systematic review by Wang (2016) on herbal adjuvants in H. pylori shows that some preparations improve adherence and reduce antibiotic side effects but do not replace them. If mastic is considered alongside eradication therapy, discuss with a gastroenterologist – as a stand-alone way to «treat H. pylori without antibiotics» it does not work.