Probiotics and autoprobiotics for treatment of Helicobacter pylori infection

Table 1 Probiotics plus eradication therapy: Assessment of probiotic action against H. pylori: Results for multi-strain probiotics (symbiotics)

Ref.	Patient characteristics	Type of eradication therapy	Type of probiotic	Results
Grgov et al[44], 2016	167 patients with dyspeptic symptoms and chronic gastritis who were diagnosed with H. pylori infection	7-d triple eradication therapy with lansoprazole continued within 4 wk	Probiotic cultures in the form of a capsule comprising Lactobacillus Rosell-52, Lactobacillus Rosell-11, Bifidobacterium Rosell-1755, and Saccharomyces boulardii	(1) Eradication rate in probiotic group-93.3%, in placebo group-81.8% (P < 0.05); and (2) The incidence of adverse effects in probiotic group –17.7%, in placebo group-28.6%
Viazis et al[45], 2022	329 patients in probiotic group and 335 patients in placebo group	10-d proton pump inhibitor containing non-bismuth quadruple therapeutic regimen	The probiotics used combined four probiotic strains, i.e., Lactobacillus Acidophilus, Lactiplantibacillus plantarum, Bifidobacterium lactis, and Saccharomyces boulardii.	(1) Eradication rate in probiotic group-92.0%, in placebo group-86.8% (P = 0.028); and (2) Probiotics significantly decrease side effects
Srinarong et al[46], 2014	100 patients (25 each receiving 7- and 14-d regimens with probiotic or placebo)	7-d and 14-d standard triple therapy plus bismuth	Probiotic bacteria composed of Bifidobacteriumlactis, Lactobacillus acidophilus, and Lactobacillus paracasei	(1) Eradication rates of 7- or 14 d regimens with probiotics were 100%; and (2) The incidence of bitter taste was significantly lower in the probiotic group compared with placebo (40% vs 64%; P = 0.04)
Hauser et al[47], 2015	650 patients	Standard triple eradication therapy	Lactobacillus rhamnosus GG (LGG®) and Bifidobacterium (BB-12®) at a concentration of 108 to 1010 living bacteria	(1) Eradication rate: Probiotics vs placebo-87.38% vs 72.55%; P < 0.001; and (2) Adding probiotics to the standard triple therapy distinctly decreases the adverse effects of therapy
McNicholl et al[48], 2018	209 H. pylori positive patients	33% triple therapy, 66% non-bismuth quadruple therapy	1 × 109 colony-forming units each strain, Lactobacillus plantarum and Pediococcus acidilactici	Probiotic supplementation containing Lactobacillus Plantarum and Pediococcus acidilactici to H. pylori treatment neither decreased side effects nor improved compliance with therapy or eradication rates
Tongtawee et al[49], 2015	200 infected patients	Tailored triple therapy	Pretreatment with probiotics (Lactobacillus delbrueckii and Streptococcus thermophillus) containing yogurt	(1) Eradication rate in probiotic group-90.8%, in placebo group-84.3% (P = 0.04); and (2) Adding probiotics does not reduce adverse effects of the medication
Shavakhi et al[50], 2013	84 patients in the probiotic and 86 in the placebo group	Bismuth-containing quadruple therapy	Probiotic compound contained seven bacterial species including Lactobacillus, Bifidobacterium spp., and Streptococcus thermophiles	(1) Eradication rate in probiotic group-82.1%, in placebo group-81.1% (P = 0.392); and (2) Diarrhea was less frequent (2.2 vs 11.1%, P = 0.016), while abdominal pain was more frequent (10 vs 2.2%, P = 0.029) in the probiotic group
Wang et al[51], 2014	88 H. pylori-infected children: Treatment group (n = 43), control group (n = 45)	Standard triple therapy	Lactobacillus acidophilus and Bifidobacterium bifidum	The eradication rate in probiotic group - 83.7, in placebo group-64.4 % (P < 0.05)
Navarro-Rodriguez et al[52], 2013	107 patients: 55 patients with active probiotics and 52 with placebo	7-d furazolidone, tetracycline, and lansoprazole regimen	Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, and Streptococcus faecium twice a day for 30 d	(1) The eradication rate with probiotics was 89.8% and with placebo, 85.1% (P = 0.49); and (2) The rate of adverse effects at 7 d with probiotics was 59.3% and 71.2% with placebo (P = 0.20)
Tolone et al[53], 2012	68 histopathologically proven H. pylori-infected children	Standard triple therapy	Lactobacillus plantarum 5 × 109, L. reuterii 2 × 109, L. casei subsp. Rhamnosus 2 × 109, Bifidobacterium infantis and B. longum 2 × 109, L. salivarius 109, L. acidophilus 109, Streptococcus termophilus 5 × 109, and L. sporogenes 109	(1) The eradication rate with probiotics was 88.2% and without probiotics 76,4% (P = 0.1); and (2) The addition of a probiotic formula to triple therapy significantly decreased the frequency of epigastric pain, nausea, vomiting, and diarrhea

Table 2 Probiotics plus eradication therapy: Assessment of probiotic action against H. pylori: Results for Bifidobacterium spp. probiotics

Ref.	Patient characteristics	Type of eradication therapy	Type of probiotic	Results
Çekin et al[54], 2017	159 patients with H. pylori infection	14-d sequential H. pylori eradication therapy	Bifidobacterium animalis subsp. lactis B94 1 capsule/d	(1) Eradication rates in the probiotic group/placebo group were 86.8% vs 70.8%, P = 0.025; (2) Lower first week diarrhea; and (3) Less common self-reported side effects and higher treatment compliance
Dajani et al[55], 2013	377 patients	Standard triple therapy, sequential treatment	Bifidus infantis 2036 at 30 × 108 colony-forming units twice daily	Eradication rate: Standard therapy-68.9%, probiotic with triple therapy- 83%, pre-treatment before triple therapy-90.5%, probiotic with sequential therapy-90.8% (P < 0.05)

Table 3 Probiotics plus eradication therapy: Assessment of probiotic action against H. pylori: Results for Lactobacillus spp. probiotics

Ref.	Patient characteristics	Type of eradication therapy	Type of probiotic	Results
Poonyam et al[56], 2019	100 subjects were enrolled (72 females, 28 males, mean age = 54 years)	PPI and bismuth-containing quadruple therapy	Lactobacillus reuteri (Biogaia®) in tablets twice daily	(1) Eradication rates with probiotic/placebo were 68%/72% of 7-d regimens and 96%/88% of 14-d regimens; and (2) The incidence of adverse effects was significantly lower in patients in probiotics group
Yang et al[57], 2021	200 treatment-naive H. pylori-positive adult patients	14-d standard triple therapy	Lactobacillus reuteri DSM17648	(1) Eradication rate in the probiotic group - 81.8%, in placebo group-83.7% (P = 0.730); and (2) Probiotic helps improve the microbial profile and reduce the frequency of abdominal distention and diarrhea
Zhu et al[58], 2017	416 children with H. pylori infection	Standard triple therapy, sequential treatment	Lactobacillus	Eradication rate: Sequential group -80.4%, triple group-74%, sequential Lactobacillus group-90.8%, triple Lactobacillus group -88.6%
Francavilla et al[59], 2014	100 H. pylori-positive naive patients	Standard triple therapy	L. reuteri combination (2 × 10 colony-forming units) or placebo during a 3-phase study (pre-eradication, eradication, and follow-up)	(1) Eradication rate was 75% in L. reuteri combination and 65.9% in placebo (P = NS); (2) Significantly less patients in L. reuteri combination as compared with placebo-reported side effects (40.9% vs 62.8%; P < 0.04); and (3) An abnormal gastrin-17 value was found in patients receiving placebo as compared with L. reuteri combination (28% vs 12%; P < 0.02)
Moreno Márquez et al[60], 2022	80 patients	Bismuth-containing quadruple eradication therapy	Lactobacillus reuteri strains (DSM 17938 and ATCC PTA 6475)	(1) Eradication therapy was effective in 85 % of patients, with no differences between treatment arms; and (2) Treatment with L. reuteri only reduced abdominal pain and distension (P < 0.001)
Du et al[61], 2012	234 gastritis patients	Clarithromycin-based triple therapy	Lactobacillus acidophilus 3 × 107	Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates
Naghibzadeh et al[62], 2022	Quadruple therapy plus L. reuteri (52 patients); Quadruple therapy only (52 patients)	Quadruple therapy: Proton pomp inhibitor, bismuth subcitrate, clarithromycin, and amoxicillin	Lactobacillus reuteri DSMZ 17648	Eradication rate in probiotic group-92.3%, in control group - 86.5%

Table 4 Probiotics plus eradication therapy: Assessment of probiotic action against H. pylori: Results for Saccharomyces boulardii probiotics

Ref.	Patient characteristics	Type of eradication therapy	Type of probiotic	Results
Seddik et al[63], 2019	199 patients (51.3% males; mean age 44.6 ± 13.6 years)	Standard sequential therapy	Saccharomyces boulardii CNCM I-745	(1) Eradication rate in the probiotic group - 86%, in placebo group – 74.7% (P = 0.02); and (2) Incidence of adverse events in probiotic group - 17%, in placebo group – 55.7% (P < 0.001)
He et al[64], 2019	300 H. pylori-infected patients	Bismuth quadruple therapy	Saccharomyces boulardii	(1) Eradication rate in probiotic group-90.4%, in placebo group-89.0% (P = 0.87); and (2) The overall incidence of adverse reactions and the incidence of diarrhea and nausea in the probiotic group was lower than those in the quadruple group (P < 0.05)
Zhao et al[65], 2014	240 children with a confirmed diagnosis of H. pylori infection	14-d standard triple therapy	Saccharomyces boulardii	(1) The eradication rate was 75.8% in the triple therapy group and 85% in the probiotic group (P > 0.05); and (2) The incidence of stomatitis, constipation, and diarrhea was significantly lower in probiotic group (P < 0.05)
Chang et al[43], 2019	122 patients with infections not resistant to clarithromycin: Triple therapy only (group A, n=61), triple therapy plus probiotics (group B, n = 61)	Clarithromycin-based triple therapy	Saccharomyces boulardii	(1) The eradication rates were similar among the groups both in the intention-to-treat (A = 85.2%, B = 89.6%) and per-protocol (A = 89.2%, B = 86.8%) analyses; and (2) The frequencies of overall adverse events in the groups also did not differ (A vs B: P = 0.574)