Lau CSM, et al. – Authors performed this meta–analysis determining the impact of probiotic supplementation on the efficacy of standard triple therapy in eradicating H. pylori. Findings suggested a beneficial impact of probiotics addition regarding H. pylori eradication rates in both children and adults, as well as Asians and non–Asians. In addition, the reduction in antibiotic–associated side effects such as nausea, vomiting, diarrhea, and epigastric pain seemed improving medication tolerance and patient compliance. Given the consequences associated with chronic H. pylori infection, they suggest addition of probiotics to the concurrent triple therapy regimen in all patients with H. pylori infection. However, to identify the optimal probiotic species and dose, further studies were recommended.

Methods

• Authors performed a comprehensive literature search using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (time of inception to 2016) to identify all published randomized control trials (RCTs) assessing the use of probiotics in addition to triple therapy for the treatment of H. pylori.
• Keywords used for the search included: “probiotics”, “triple therapy”, and “Helicobacter pylori”.
• They included RCTs comparing the use of probiotics and standard triple therapy with standard triple therapy alone for any duration in patients of any age diagnosed with H. pylori infection.
• Analysis of H. pylori eradication rates (detected using urea breath test or stool antigen) was performed as–per–protocol (APP) and intention–to–treat (ITT).

Results

• Analysis of 30 RCTs involving 4,302 patients APP and 4,515 patients ITT was performed.
• Probiotics addition significantly increased eradication rates by 12.2% (relative risk [RR] =1.122; 95% confidence interval [CI], 1.091–1.153; P<0.001) APP and 14.1% (RR =1.141; 95% CI, 1.106–1.175; P<0.001) ITT.
• Probiotics proved valuable among children and adults, as well as Asians and non–Asians.
• There appeared no significant difference in efficacy between the various types of probiotics.
• Reduction in the risk of diarrhea, nausea, vomiting, and epigastric pain was also observed.