Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2012; 18(43): 6302-6307
Published online Nov 21, 2012. doi: 10.3748/wjg.v18.i43.6302
Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection
Yi-Qi Du, Tun Su, Jian-Gao Fan, Yu-Xia Lu, Ping Zheng, Xing-Hua Li, Chuan-Yong Guo, Ping Xu, Yan-Fang Gong, Zhao-Shen Li
Yi-Qi Du, Tun Su, Yan-Fang Gong, Zhao-Shen Li, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
Jian-Gao Fan, Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200240, China
Yu-Xia Lu, Department of Gastroenterology, Tongji Hospital, Tong Ji University, Shanghai 200092, China
Ping Zheng, Department of Gastroenterology, Shanghai First People’s Hospital, Shanghai 201620, China
Xing-Hua Li, Department of Gastroenterology, Shanghai Eighth People’s Hospital, Shanghai 210035, China
Chuan-Yong Guo, Department of Gastroenterology, Shanghai Tenth People’s Hospital, Shanghai 200072, China
Ping Xu, Department of Gastroenterology, Shanghai Songjiang Centeral Hospital, Shanghai 201100, China
Author contributions: Du YQ and Li ZS designed the study; Su T, Fan JG, Lu YX, Zheng P, Li XH, Guo CY and Xu P enrolled patients in each center and collected the data; Gong YF performed breath tests; Du YQ analyzed the data, wrote and revised the paper; Li ZS supervised the study; all authors have read and approved the final version to be published.
Supported by A grant from the China National Science and Technology Major Project, No. 2012ZX09303-011-002
Correspondence to: Zhao-Shen Li, Professor, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China. zhsli@81890.net
Telephone: +86-21-81873241 Fax: +86-21-55621735
Received: June 17, 2012
Revised: September 10, 2012
Accepted: September 12, 2012
Published online: November 21, 2012
Abstract

AIM: To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori) infection.

METHODS: This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid, clarithromycin 500 mg bid, and amoxicillin 1000 mg bid; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods.

RESULTS: PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction.

CONCLUSION: Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.

Keywords: Helicobacter pylori; Probiotic; Eradication