Lactobacillus reuteri in management of Helicobacter pylori infection in dyspeptic patients: a double-blind placebo-controlled randomized clinical trial

Abstract

Introduction: The eradication rate of Helicobacter pylori following the standard triple therapy is declining. This study was conducted to test whether the addition of Lactobacillus reuteri to the standard triple therapy improves the eradication rates as well as the clinical and pathological aspects in H. pylori infection. Methods: A total of 70 treatment-naïve patients were randomly assigned into group A (the L. reuteri treated group) and group B (the placebo control group). Patients were treated by the standard triple therapy for 2 weeks and either L. reuteri or placebo for 4 weeks. They were examined by symptom questionnaire, H. pylori antigen in stool, upper endoscopy with biopsies for rapid urease test and histopathological examination before treatment and 4 weeks after treatment. Results: The eradication rate of H. pylori infection was 74.3% and 65.7% for both L. reuteri and placebo treated groups, respectively. There was a significant difference regarding the reported side effects, where patients treated with L. reuteri reported less diarrhea and taste disorders than placebo group. A significant difference within each group was observed after treatment regarding Gastrointestinal Symptom Rating Scale (GSRS) scores; patients treated with L. reuteri showed more improvement of gastrointestinal symptoms than the placebo treated group. The severity and activity of H. pylori associated gastritis were reduced after 4 weeks of therapy in both groups. The L. reuteri treated group showed significant improvement compared with the placebo treated group. Conclusion: Triple therapy of H. pylori supplemented with L. reuteri increased eradication rate by 8.6%, improved the GSRS score, reduced the reported side effects and improved the histological features of H. pylori infection when compared with placebo-supplemented triple therapy.

Meta-analysis of the efficacy of probiotics inHelicobacter pylorieradication therapy

“…Our results show that there was no significant difference in the pooled indices of the eight studies with Jadad scores ≥ 3, in the 12 studies that used single probiotic preparations, or when the 14 studies were included. There was also no significant difference between studies that used triple therapy regimens lasting Emara et al [15] HpSA, RUT, Histology HpSA, RUT, Histology 4 wk 1 0.00% Non-Boer 6 wk 2 Medeiros et al [16] Culture UBT ≥ 6 wk 0.00% Not reported Song et al [17] RUT, Histology UBT 4 wk 8.50% Non-Boer Du et al [18] RUT, UBT, Pathologic examination UBT 4 wk 2.60% Non-Boer…”

“…Eighty-eight studies were excluded after more detailed assessments were made (21 studies were in animals or in vitro, 14 studies were in children, 13 studies did not use a standard triple therapy, 21 were unrelated studies, and 5 studies had no rigorous inclusion criteria), and the remaining 14 studies [15][16][17][18][19][20][21][22][23][24][25][26][27][28] were considered suitable for inclusion in the analysis. A flow diagram of the study selection process is shown in Figure 1.…”

Is There a Role for Probiotics in Helicobacter pylori Therapy?

“…In 1 study where 70 naıve patients were treated, Lactobacillus reuteri increased eradication rate by 8.6% and reduced the reported side effects when compared with placebo-supplemented triple therapy. 27 A metaanalysis of 9 studies on probiotic use as an adjunct to triple therapy found that when specific Lactobacillus strains were used, eradication rates increased significantly by 17%, but when multistrain probiotics were used, eradication rates enhanced by only 2.8%. 28 This also was reflected in 2 other trials from Iran and Brazil where multistrain probiotics as adjunct therapy failed to show a benefit for eradication.…”

“…29,30 In scenarios characterized by low H pylori eradication rates, the addition of L reuteri may lead to a therapeutic gain of 10%. 27 The strength of probiotics as add-on therapy, however, is their ability to reduce antibiotic side effects and thereby improve adherence. 27,32,33 In contrast, Navarro-Rodriguez and colleagues 30 concluded that the use of probiotic compound (Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifido bacterium, and Streptococcus faecium) compared with placebo in the regimen in Brazilian patients with peptic ulcer or functional dyspepsia showed no difference in efficacy or adverse effects rate.…”

Yogurt Containing <b><i>Lactobacillus gasseri</i></b> Mitigates Aspirin-Induced Small Bowel Injuries: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial

“…In this study, the consumption of LG for 6 weeks significantly improved both the GSRS and FSSG scores. Emara et al [26] reported that L. reuteri significantly improved the GSRS in a double-blind placebo-controlled randomized trial. However, the improvements of symptoms were limited to the fore gut including epigastric pain, sucking sensation in the epigastrium, and eructation.…”