Efficacy and safety of probiotics as adjuvant agents for Helicobacter pylori infection: A meta-analysis

Abstract

The aim of the present study was to determine whether probiotics could help to improve the eradication rates and reduce the side effects associated with anti-Helicobacter pylori treatment, and to investigate the optimal time and duration of probiotic administration during the treatment, thus providing clinical practice guidelines for eradication success worldwide. By searching Pubmed, Embase, the Cochrane Central Register of Controlled Trials and the Science Citation Index, all the randomized controlled trials (RCTs) comparing probiotics as adjuvant agents of anti-H. pylori standard triple-therapy regimens with placebo or no treatment were selected. Statistical analysis was performed with the Comprehensive Meta Analysis Software. Subgroup, meta-regression and sensitivity analyses were also carried out. Twenty-one RCTs involving a total of 3,814 participants met the inclusion criteria. The pooled eradication rates of the probiotic group were 80.3% (1,709/2,128) by intention-to-treat (ITT) and 83.8% (1,709/2,039) by pro-protocol analyses; the pooled relative risk (RR) by ITT for probiotic supplementation versus treatment without probiotics was 1.12 [95% confidence interval (CI), 1.06–1.19]. A reduced risk of overall H. pylori therapy-related adverse effects was also found with probiotic supplementation (RR, 0.60; 95% CI, 0.40–0.91). The subgroup analyses showed that probiotic supplementation prior and subsequent to the treatment regimen both improved eradication rates for H. pylori infection. Furthermore, probiotic treatment lasting >2 weeks and including Lactobacillus or multiple probiotic strains significantly enhanced the efficacy. In conclusion, supplementation with probiotics for H. pylori eradication may be effective in increasing eradication rates and decreasing therapy-related side effects. Probiotic administration prior or subsequent to therapy and for a duration of >2 weeks may increase the eradication efficacy.

Antibiotic treatment forHelicobacter pylori: Is the end coming?

“…Although some studies have reported that probiotics alone have limited efficacy [125,126] , they can be useful when used as a supplemental drug. In a study by Lv et al [127] , the cure rates in the probiotic supplementation group were superior to those in the group that did not receive probiotics (RR, 1.12; 95%CI: 1.06-1.19), and probiotics reduced the risk of H. pylori therapy related side effects (RR, 0.60; 95%CI: 0.40-0.91). In another meta-analysis, the pooled odd ratios (ORs) for the eradication rate were higher in the probiotic group than the control group (OR = 1.67; 95%CI: 1.38-2.02) by ITT, and adverse effects were lower in the probiotic group (OR = 0.49, 95%CI: 0.26-0.94) [128] .…”

Use of probiotics as an adjuvant to sequential H. pylori eradication therapy: impact on eradication rates, treatment resistance, treatment-related side effects, and patient compliance

“…Owing to the growing need for newer alternative eradication regimens or adjuvant treatments, the addition of probiotics (administration of live microbial species) has been considered likely to offer beneficial health effects (15) and thus has attracted substantial interest with respect to H. pylori eradication therapy (16)(17)(18)(19). On the basis of the demonstration of anti-H. pylori activity of probiotics such as Lactobacillus, Saccharomyces boulardii, and Bifidobacterium, in in vitro and experimental models of H. pylori infection (19), probiotics have been suggested to improve H. pylori eradication and reduce side effects during therapy (17,20,21).…”

“…On the basis of the demonstration of anti-H. pylori activity of probiotics such as Lactobacillus, Saccharomyces boulardii, and Bifidobacterium, in in vitro and experimental models of H. pylori infection (19), probiotics have been suggested to improve H. pylori eradication and reduce side effects during therapy (17,20,21). However, findings from clinical studies on the use of probiotics as an adjuvant therapy to H. pylori infection have been inconsistent, with the demonstration of reduced side effects of antibiotics and improved eradication rates in some studies (16,(22)(23)(24)(25)(26)(27)(28)(29)(30), while no significant effects of adjuvant probiotics on eradication rates (22,(31)(32)(33)(34)(35)(36) or side effects (26,27,30,31,32,33,(35)(36)(37) have been reported in other studies.…”

The effects of helicobacter pylori infection on nutrition status and metabolism

“…Using probiotics in the treatment of H.pylori can reduce the side effects and using probiotics more than two week and including lactobacillus significantly enhanced the efficacy of the eradication 44 . Probiotics have shown their positive effects via maintaining gastric mucosal barrier and acidity and providing protection against the harmful effects of H.pylori infection.…”

“…In addition, probiotics provide a better compliance the treatment as a result of reduced side effects to the intestines 45 . Mechanisms explaining the effects of probiotics on H.pylori are described as; competing against H.pylori on the gastric mucosal epithelium, providing the production of anti H.pylori substances such as acetic acid, propionic acid and butyric acid, supporting the regulation of immune functions and immunoglobulin-A secretion to improve mucosal defensive ability and strengthening the bonds between epithelial cells 44 . Although probiotics have beneficial effects on H.pylori, the impacts on H.pylori eradication are still controversial due to insufficient data on the effctive certain strain and dosage of probiotics 46 .…”