Dargenio VN, Ricciardi S, Begucci M, La Grasta G, Maggi N, Dargenio C, Castellaneta SP, Cristofori F, Francavilla R. Lactobacillus supplementation for Helicobacter pylori eradication in children: A language-inclusive systematic review and meta-analysis of efficacy and safety. World J Clin Pediatr 2026; 15(3): 118791 [DOI: 10.5409/wjcp.118791]
Corresponding Author of This Article
Fernanda Cristofori, MD, PhD, Interdisciplinary Department of Medicine, Pediatric Section, Children’s Hospital ‘Giovanni XXIII’, University of Bari “Aldo Moro”, Bari 70126, Puglia, Italy. fernandacristofori@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Dargenio VN, Ricciardi S, Begucci M, La Grasta G, Maggi N, Dargenio C, Castellaneta SP, Cristofori F, Francavilla R. Lactobacillus supplementation for Helicobacter pylori eradication in children: A language-inclusive systematic review and meta-analysis of efficacy and safety. World J Clin Pediatr 2026; 15(3): 118791 [DOI: 10.5409/wjcp.118791]
World J Clin Pediatr. Sep 9, 2026; 15(3): 118791 Published online Sep 9, 2026. doi: 10.5409/wjcp.118791
Lactobacillus supplementation for Helicobacter pylori eradication in children: A language-inclusive systematic review and meta-analysis of efficacy and safety
Vanessa Nadia Dargenio, Sara Ricciardi, Martina Begucci, Giovanni La Grasta, Nadia Maggi, Costantino Dargenio, Stefania Paola Castellaneta, Fernanda Cristofori, Ruggiero Francavilla
Vanessa Nadia Dargenio, Sara Ricciardi, Martina Begucci, Giovanni La Grasta, Nadia Maggi, Costantino Dargenio, Stefania Paola Castellaneta, Fernanda Cristofori, Ruggiero Francavilla, Interdisciplinary Department of Medicine, Pediatric Section, Children’s Hospital ‘Giovanni XXIII’, University of Bari “Aldo Moro”, Bari 70126, Puglia, Italy
Author contributions: Francavilla R and Cristofori F designed the research study; Begucci M, La Grasta G, Maggi N and Castellaneta SP performed the research; Dargenio VN, Ricciardi S and Dargenio C performed the literature search and wrote the original draft; Francavilla R, Cristofori F, Dargenio VN and Castellaneta SP reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.
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: The authors declare no conflicts of interest.
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: Fernanda Cristofori, MD, PhD, Interdisciplinary Department of Medicine, Pediatric Section, Children’s Hospital ‘Giovanni XXIII’, University of Bari “Aldo Moro”, Bari 70126, Puglia, Italy. fernandacristofori@gmail.com
Received: January 12, 2026 Revised: February 17, 2026 Accepted: May 29, 2026 Published online: September 9, 2026 Processing time: 202 Days and 2 Hours
Abstract
BACKGROUND
Increasing antibiotic resistance has reduced the effectiveness of standard Helicobacter pylori (H. pylori) eradication therapies in children. Probiotics, particularly Lactobacillus species, have been proposed as adjuvants to improve treatment outcomes and reduce side effects.
AIM
To evaluate the efficacy and safety of Lactobacillus spp. alongside standard eradication therapy in pediatric populations, emphasizing globally representative evidence through inclusion of non-English studies, especially from high-prevalence regions such as China.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed/MEDLINE, Cochrane CENTRAL, Scopus, and four Chinese databases. Primary outcome was eradication rate; secondary outcomes included overall and specific adverse events (AEs). Subgroup analyses evaluated probiotic dosage, supplementation duration, and eradication regimen.
RESULTS
Thirteen RCTs involving 1428 children were included; eight were conducted in China. Lactobacillus spp. significantly improved eradication rates [89.7% vs 72.3%; relative risk (RR) = 1.24, 95% confidence interval (CI): 1.15-1.34, I2 = 45%]. The effect was most pronounced in triple therapy (RR = 1.28, 95%CI: 1.17-1.40) and with higher probiotic doses (≥ 5 × 109 colony-forming units/day; RR = 1.36, 95%CI: 1.15-1.60). Lactobacillus spp. also significantly reduced overall AEs (RR = 0.50, 95%CI: 0.30-0.84), particularly diarrhea (RR = 0.49, 95%CI: 0.27-0.92), nausea/vomiting (RR = 0.66, 95%CI: 0.45-0.95), and taste disturbances (RR = 0.42, 95%CI: 0.23-0.76).
CONCLUSION
Adjunctive Lactobacillus therapy significantly enhances H. pylori eradication rates and reduces treatment-related adverse effects in children. Its benefits are dose-dependent and most evident in triple therapy regimens. Inclusion of Chinese and other non-English studies provides the most geographically comprehensive evidence to date, supporting the use of Lactobacillus probiotics as a complementary strategy to optimize H. pylori management in pediatric patients across diverse global settings.
Core Tip: Adjunctive Lactobacillus supplementation significantly enhances Helicobacter pylori (H. pylori) eradication rates in children and reduces treatment-related adverse effects. Evidence from this meta-analysis, which includes a substantial number of non-English and Chinese studies, demonstrates that probiotics are particularly effective when combined with standard triple therapy and when administered at higher doses. These findings support Lactobacillus probiotics as a safe, effective, and globally relevant complementary strategy for optimizing pediatric H. pylori treatment.
