Multi-strain fermented milk promotes gut microbiota recovery after Helicobacter pylori therapy: a randomised, controlled trial

Abstract

BACKGROUNDHelicobacter pylori (Hp) eradication therapy can alter gut microbiota, provoking gastro-intestinal (GI) symptoms that can be improved by probiotics. The effect on Hp patients of a Test fermented milk containing yogurt and three Lacticaseibacillus (L. paracasei CNCM I-1518, CNCM I-3689, L. rhamnosus CNCM I-3690) strains was assessed on antibiotic associated diarrhea (AAD) (primary aim), GI-symptoms, gut microbiota composition and metabolites. In this aim, a randomized, double-blind, controlled trial was performed in 136 adults under Hp-treatment (14-day amoxicillin, clarithromycin, pantoprazole), who consumed the Test or a Control product for 28 days. Feces were analysed for gut microbiota composition, short chain fatty acids (SCFA), calprotectin, and viability of ingested strains.RESULTSNo effect of Test product was observed on AAD occurrence or duration, rating scores or number of days of GI symptoms. Hp-treatment induced a significant alteration in bacterial and fungal composition, a decrease of bacterial count and alpha-diversity, an increase of Candida and of calprotectin, and a decrease of SCFA concentration. Following Hp treatment, in the Test as compared to Control group, intra-subject beta-diversity distance from baseline was lower (padj=0.02), Escherichia-Shigella (padj=0.0082) and Klebsiella (padj= 0.013) were significantly less abundant, and concentrations of major SCFA (p=0.035) and valerate (p = 0.045) were higher. Viable Lp and Lr strains from the Test product were mainly detected during product consumption in feces.CONCLUSIONSThe study showed that 14-day Hp triple therapy alters gut bacterial and fungal community, their metabolites and gut inflammatory markers. Consumption of a multi-strain fermented milk can induce faster recovery of the microbiota composition and SCFA production and limit the bloom of pathobionts. (ClinicalTrials.gov, NCT02900196; First Posted : September 14, 2016; https://www.clinicaltrials.gov/ct2/show/NCT02900196).

The Human Gut Microbiota in all its States: From Disturbance to Resilience

“…A lower intra-subject beta-diversity distance from baseline was observed together with a lower abundance of Escherichia, Shigella and Klebsiella was reported up to one month following cessation of the treatment in subjects who consumed the multistrain product. However, the gut microbiota's alteration was not reflected by gastrointestinal symptoms (Guillemard et al, 2021). In another study, no effect on alpha and beta-diversity compared to the control group was reported after 14-days of ingestion of freeze-dried L. helveticus R0052 and L. rhamnosus R0011 by subjects undergoing amoxicillin-clavulanate treatment, however the supplementation with the probiotic significantly reduced the duration of diarrhea (Macpherson et al, 2018).…”

“…However, many studies have relied on low resolution profiling approaches, which did not allow capture of the whole community (reviewed in (McFarland, 2014)). Some studies in adults showed the capacity of some bacterial or fungal strains to modulate the recovery of gut microbiota (Guillemard et al, 2021;Suez et al, 2018;Macpherson et al, 2018;Kabbani et al, 2017). In a high-resolution sampling scheme, Suez et al showed that ingestion of a mixture of 11 strains (lactic acid bacteria and bifidobacteria, L. acidophilus, L. casei, L. casei sbsp.…”