“…There is, however, no agreement about the underlying mechanisms. Currently, several hypotheses based on in vitro studies have been proposed: inhibition of adhesion of H. pylori cells to gastric epithelial cells [38,42,44,54,57]; production of organic acids-mainly lactic acid-by the probiotic strains, and low pH [1,8,44]; secretion of an antibacterial substance different from lactic acid [3,12,13,47,57,60]; a combined effect of lactic acid and other extracellularly secreted compounds [52,79]; an intracellular compound that is released after cell lysis [46]; and immunomodulation [63,68,82].…”