Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4345-4357
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4345
Probiotics in Helicobacter pylori eradication therapy: A systematic review and meta-analysis
Min-Min Zhang, Wei Qian, Ying-Yi Qin, Jia He, Yu-Hao Zhou
Min-Min Zhang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
Wei Qian, Center for Clinical Epidemiology and Evidence-Based Medicine, Second Military Medical University, Shanghai 200433, China
Ying-Yi Qin, Jia He, Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
Yu-Hao Zhou, Department of Rehabilitation Institute, Shanghai Seventh People’s Hospital, Shanghai 200137, China
Author contributions: Zhang MM, Qian W, and Qin YY contributed equally to this work; Zhou YH and He J designed the research; Zhang MM, Qian W, and Qin YY performed the research; Zhou YH and He J contributed new reagents/analytic tools; Zhou YH analyzed the data; Qian W, Zhang MM and Zhou YH wrote the paper.
Supported by Grant from the Ministry of Science and Technology of China, No. 2008ZX10002-007, No. 2008ZX10002-018, and No. 2008ZX10002-025; the Leading Talents of Science in Shanghai 2010 (022); the Key Discipline Construction of Evidence-Based Public Health in Shanghai, No. 12GWZX0602; and the National Science Foundation of China, No. 81373105.
Correspondence to: Dr. Yu-Hao Zhou, Department of Rehabilitation Institute, Shanghai Seventh People’s Hospital, No. 358 Datong Road, Pudong New Area, Shanghai 200137, China. zhou_ly@126.com
Telephone: +86-21-58611047 Fax: +86-21-58611047
Received: July 17, 2014
Peer-review started: July 17, 2014
First decision: August 15, 2014
Revised: September 4, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: April 14, 2015
Processing time: 272 Days and 2 Hours
Abstract

AIM: To summarize the evidence from randomized controlled trials (RCTs) regarding the effect of probiotics by using a meta-analytic approach.

METHODS: In July 2013, we searched PubMed, EMBASE, Ovid, the Cochrane Library, and three Chinese databases (Chinese Biomedical Literature Database, Chinese Medical Current Content, and Chinese Scientific Journals database) to identify relevant RCTs. We included RCTs investigating the effect of a combination of probiotics and standard therapy (probiotics group) with standard therapy alone (control group). Risk ratios (RRs) were used to measure the effect of probiotics plus standard therapy on Helicobacter pylori (H. pylori) eradication rates, adverse events, and patient compliance using a random-effect model.

RESULTS: We included data on 6997 participants from 45 RCTs, the overall eradication rates of the probiotic group and the control group were 82.31% and 72.08%, respectively. We noted that the use of probiotics plus standard therapy was associated with an increased eradication rate by per-protocol set analysis (RR = 1.11; 95%CI: 1.08-1.15; P < 0.001) or intention-to-treat analysis (RR = 1.13; 95%CI: 1.10-1.16; P < 0.001). Furthermore, the incidence of adverse events was 21.44% in the probiotics group and 36.27% in the control group, and it was found that the probiotics plus standard therapy significantly reduced the risk of adverse events (RR = 0.59; 95%CI: 0.48-0.71; P < 0.001), which demonstrated a favorable effect of probiotics in reducing adverse events associated with H. pylori eradication therapy. The specific reduction in adverse events ranged from 30% to 59%, and this reduction was statistically significant. Finally, probiotics plus standard therapy had little or no effect on patient compliance (RR = 0.98; 95%CI: 0.68-1.39; P = 0.889).

CONCLUSION: The use of probiotics plus standard therapy was associated with an increase in the H. pylori eradication rate, and a reduction in adverse events resulting from treatment in the general population. However, this therapy did not improve patient compliance.

Keywords: Probiotics; Helicobacter pylori; Eradication; Systematic review; Meta-analysis

Core tip: Probiotics have a positive effect on Helicobacter pylori (H. pylori) eradication since these compounds also induce anti-inflammatory and anti-oxidative mechanisms that regulate intestinal microbiota. The benefits of probiotics supplementation in the treatment of antibiotic resistant H. pylori are still unclear due to the lack of supporting evidence. In this meta-analysis of 45 randomized controlled trials involving nearly 6997 individuals, we found that the use of probiotics plus standard therapy was associated with an increase in the H. pylori eradication rate, and a reduction in adverse events resulting from treatment in the general population. However, this therapy did not improve patient compliance.