Limosilactobacillus reuteri DSM 17938 and PTA 6475 as adjunct in Helicobacter pylori therapy: Systematic review and meta-analysis

doi:10.3748/wjg.119222

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Oct 7, 2026; 32(37): 119222
Published online Oct 7, 2026. doi: 10.3748/wjg.119222

Limosilactobacillus reuteri DSM 17938 and PTA 6475 as adjunct in Helicobacter pylori therapy: Systematic review and meta-analysis

Ruggiero Francavilla, Andrea Iannone, Fernanda Cristofori, Alessia Cafforio, Vanessa N Dargenio, Giovanni La Grasta, Viviana F Brindicci, Stefania P Castellaneta, Michele Barone

Ruggiero Francavilla, Fernanda Cristofori, Alessia Cafforio, Vanessa N Dargenio, Giovanni La Grasta, Viviana F Brindicci, Stefania P Castellaneta, Interdisciplinary Department of Medicine, Pediatric Section, Children’s Hospital ‘Giovanni XXIII’, University of Bari “Aldo Moro”, Bari 70126, Puglia, Italy

Andrea Iannone, Michele Barone, Department of Precision and Regenerative Medicine, Gastroenterology Section, Policlinic University Hospital, University of Bari “Aldo Moro”, Bari 70124, Puglia, Italy

Author contributions: Francavilla R contributed to conceptualization, methodology, project administration, supervision, writing original draft preparation, writing review and editing; Iannone A contributed to conceptualization, methodology, formal analysis, writing original draft preparation; Cristofori F contributed to data curation, investigation, writing original draft preparation; Cafforio A contributed to investigation, validation; Dargenio VN contributed to data curation, investigation, validation, writing original draft preparation; La Grasta G contributed to formal analysis, visualization; Brindicci VF contributed to data curation, investigation, writing review and editing; Castellaneta SP contributed to validation, writing review and editing; Barone M contributed to methodology, project administration, data curation, validation, writing review and editing, supervision; all authors approved the final version of the manuscript, including the authorship list.

AI contribution statement: Grammarly was used for language polishing, to correct grammar and improve readability. No AI was used for data analysis or content generation No portion of the main text was generated by AI. The study design and interpretation of results were performed entirely by the human authors. No images were created using AI tools. The authors assume full responsibility for the originality, accuracy, and integrity of all content, including any portions where AI tools were used for language or formatting assistance. No AI tool was used to replace critical scientific decisions or to generate core scientific conclusions.

Conflict-of-interest statement: Francavilla R has received research support and speaker fees from various companies in unrelated projects, the present work was entirely independent and not supported by any commercial sponsor. All data were independently extracted and verified by two authors (Cristofori F and Barone M), and statistical analyses were cross-checked by authors with no industry affiliation. All authors had full access to the raw data, which are available upon reasonable request. No industry entity had any role in study design, data collection, analysis, manuscript preparation, or decision to publish.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.

Corresponding author: Ruggiero Francavilla, MD, Full Professor, Interdisciplinary Department of Medicine, Pediatric Section, Children’s Hospital ‘Giovanni XXIII’, University of Bari “Aldo Moro”, Via Giovanni Amendola, 207, Bari 70126, Puglia, Italy. ruggiero.francavilla@uniba.it

Received: January 22, 2026
Revised: February 27, 2026
Accepted: April 23, 2026
Published online: October 7, 2026
Processing time: 222 Days and 20.4 Hours

Abstract

BACKGROUND

Gastrointestinal adverse events and rising antibiotic resistance continue to undermine the effectiveness of Helicobacter pylori (H. pylori) eradication therapy. Recently probiotics have been proposed to improve eradication rates and tolerability, particularly Limosilactobacillus reuteri (L. reuteri) DSM 17938.

AIM

To investigate with a systematic review and meta-analysis the efficacy and safety of L. reuteri DSM 17938, alone or with ATCC PTA 6475, when administered with standard eradication regimens.

METHODS

We systematically searched PubMed, EMBASE, and Cochrane Library through June 1, 2025. We followed the PRISMA 2020 guidelines, and the protocol has been registered on PROSPERO (CRD42024618170). Twelve randomized controlled trials involving 803 participants were included. The primary outcome was H. pylori eradication; secondary outcomes were antibiotic-associated side effects (AASEs).

RESULTS

Supplementation with L. reuteri did not meaningfully increase eradication rates compared with controls [risk ratio (RR) = 1.03; 95% confidence interval (CI): 0.94-1.12; I² = 31.7%], a finding that held across subgroup analyses stratified by age, antibiotic regimen, and treatment duration. Where L. reuteri showed clear benefit was in tolerability: Both DSM 17938 and PTA 6475 strains significantly reduced AASEs, such as diarrhea (RR = 0.34; 95%CI: 0.21-0.55), nausea (RR = 0.44; 95%CI: 0.32-0.60), and dysgeusia (RR = 0.44; 95%CI: 0.24-0.80). For bloating and abdominal pain, the data suggest a possible benefit, though the evidence remains inconclusive.

CONCLUSION

These probiotic strains, L. reuteri DSM 17938 alone or with PTA 6475, do not increase H. pylori eradication rates but provide significant clinically relevant reductions in AASEs. The use of this probiotic therapy may enhance patient adherence and support eradication strategies without increasing antimicrobial pressure.

Keywords: Helicobacter pylori; Limosilactobacillus reuteri; DSM 17938; PTA 6475; Probiotics; Antibiotic-associated side effects; Meta-analysis

Core Tip: Adherence to Helicobacter pylori (H. pylori) eradication therapy is often limited by gastrointestinal side effects. The administration of probiotics, particularly Limosilactobacillus reuteri (L. reuteri), as adjuncts to standard eradication regimens has been shown to improve tolerability. Our meta-analysis demonstrated that L. reuteri supplementation significantly reduced diarrhea, nausea, and dysgeusia during eradication therapy, without improving eradication rates. Benefits were consistent across randomized trials. Precision probiotics, such as L. reuteri DSM 17938, may improve patient comfort, adherence, and treatment continuity by reducing side effects. This probiotic strain may represent a promising strategy in H. pylori management.