Probiotics improve the efficacy of standard triple therapy in the eradication of <em>Helicobacter pylori</em>: a meta-analysis

Abstract

IntroductionHelicobacter pylori colonization is present in half of the world’s population and can lead to numerous gastrointestinal diseases if left untreated, including peptic ulcer disease and gastric cancer. Although concurrent triple therapy remains the recommended treatment regimen for H. pylori eradication, its success rate and efficacy have been declining. Recent studies have shown that the addition of probiotics can significantly increase eradication rates by up to 50%. This meta-analysis examines the impact of probiotic supplementation on the efficacy of standard triple therapy in eradicating H. pylori.MethodsA comprehensive literature search was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (time of inception to 2016) to identify all published randomized control trials (RCTs) assessing the use of probiotics in addition to triple therapy for the treatment of H. pylori. Searches were conducted using the keywords “probiotics”, “triple therapy”, and “Helicobacter pylori”. RCTs comparing the use of probiotics and standard triple therapy with standard triple therapy alone for any duration in patients of any age diagnosed with H. pylori infection were included. H. pylori eradication rates (detected using urea breath test or stool antigen) were analyzed as-per-protocol (APP) and intention-to-treat (ITT).ResultsA total of 30 RCTs involving 4,302 patients APP and 4,515 patients ITT were analyzed. The addition of probiotics significantly increased eradication rates by 12.2% (relative risk [RR] =1.122; 95% confidence interval [CI], 1.091–1.153; P<0.001) APP and 14.1% (RR =1.141; 95% CI, 1.106–1.175; P<0.001) ITT. Probiotics were beneficial among children and adults, as well as Asians and non-Asians. No significant difference was observed in efficacy between the various types of probiotics. The risk of diarrhea, nausea, vomiting, and epigastric pain was also reduced.ConclusionThe addition of probiotics is associated with improved H. pylori eradication rates in both children and adults, as well as Asians and non-Asians. Lactobacillus, Bifidobacterium, Saccharomyces, and mixtures of probiotics appear beneficial in H. pylori eradication. Furthermore, the reduction in antibiotic-associated side effects such as nausea, vomiting, diarrhea, and epigastric pain improves medication tolerance and patient compliance. Given the consequences associated with chronic H. pylori infection, the addition of probiotics to the concurrent triple therapy regimen should be considered in all patients with H. pylori infection. However, further studies are required to identify the optimal probiotic species and dose.

Systematic review: probiotics in the management of lower gastrointestinal symptoms – an updated evidence‐based international consensus

“…All the 6 identified studies showed a reduction in diarrhoea with probiotic consumption vs placebo. This is supported by the results of 2 recent meta‐analyses that each examined the effects of a variety of probiotics on H. pylori eradication rates (primary endpoint) and diarrhoea associated with H. pylori eradication therapy (secondary endpoint) . The first, a meta‐analysis of 13 studies (1 of which is included in the current review) involving a total of 2306 patients, found a reduced risk of diarrhoea in the probiotic group compared with the placebo group (risk ratio [RR]: 0.51; 95% confidence interval [CI]: 0.31‐0.84; P = 0.008) .…”

“…Similarly, the second meta‐analysis, which involved 4515 patients from 30 RCTs (5 of which are included in this systematic review), found a significant reduction in the risk of diarrhoea with the addition of probiotics to standard triple therapy compared with triple therapy alone (RR: 0.549; 95% CI: 0.391‐0.771; P = 0.001). The addition of probiotics to standard triple therapy also significantly increased H. pylori eradication rates compared with triple therapy alone ( P < 0.001) …”

Treatment of Helicobacter pylori infection 2017

“…A separate meta‐analysis which emphasized the heterogeneity of the 13 studies identified that pooled relative risk of eradication was significantly higher in the probiotic supplementation group than in the control group and the incidence of total antibiotic‐related side effects was lower in the probiotic supplementation group than in the control group . A further meta‐analysis of 30 randomized clinical trials with significant heterogeneity found eradication rates improved by 12.2% when probiotics were used in supplementation …”

Probiotics as an adjuvant treatment in Helicobacter pylori eradication therapy

“…Lactobacillus , Saccharomyces , Bifidobacterium and other probiotic compounds seem to be beneficial to H. pylori eradication therapy in meta‐analyses . It is difficult ot conclude which probiotic is the best for H. pylori eradication therapy based on the currently available literatures.…”

“…Moreover, variations in the ethnicity of the participants, the methods of administering probiotics and local antibiotic resistance may also have greatly influenced the results. Additionally, several metaanalyses 29,[40][41][42][43][44][45][46][47][48][49][50] have been published during the past decade covering various probiotics used in H. pylori eradication, analyzing their roles in H. pylori eradication and therapy-related adverse events such as diarrhea, nausea, dyspepsia and dysgeusia. Most of these studies have claimed that patients can benefit from supplementation with probiotics in H. pylori eradication therapy.…”