Probiotics and Helicobacter pylori
Table 3: Summary of Clinical Trials of Probiotics in Helicobacter pylori Infection – Effects on Eradication Rates Reference and Type
Eradication Therapy of Study
Canducci et al., 200065 O, R, P
Armuzzi et al., 200166 DB, R, P
Armuzzi et al., 200167 DB, R, P
Cremonini et al., 200268 DB, P, R
Sheu et al., 200269 R, P
Guo et al., 200470 R, P
Nista et al., 200471 DB, R, P
Tursi et al., 200472 O, C
Myllyluoma et al., 200573 DB, R, P
Rabeprazole + clarithromycin + amoxicillin for 1 week Rabeprazole +
clarithromycin + tinidazole for 1 week Pantoprazole +
clarithromycin + tinidazole for 1 week Rabeprazole + clarithromycin +
tinidazole for 1 week Lansoprazole + chlarithromycin +
amoxicillin for 1 week Omeprazole + amoxicillin +
furanzolidone for 1 week Rabeprazole +
clarithromycin + amoxicillin for 1 week
Ranitidine bismuth citrate + esomeprazole + amoxicillin + tinidazole for 10 days Lansoprazole + clarithromycin +
amoxicillin for 1 week
Cao et al., 200574 DB, R, P
Sikora et al., 200575 DB, R, P
Goldman et al., 200676 DB, R, P
Lionetti et al., 200677 DB, R, P
Omeprazole + amoxicillin + metronidazole for 1 week Omeprazole + amoxicillin + clarithromycin for 1 week Omeprazole + amoxicillin + clarithromycin for 1 week Omeprazole, amoxicillin,
clarithromycin, tinidazole (sequential therapy) for 10 days
Cindoruk et al., 200778 DB, R, P
Park et al., 200779 DB, R, C
Kim et al., 200880 DB, R, C
Hurduc et al., 200981 O, R, P
Szajewska et al., 200982 DB, R, P
Lansoprazole + amoxicillin + clarithromycin for 2 weeks Omeprazole + amoxicillin + clarithromycin for 1 week Omeprazole + amoxicillin + clarithromycin for 1 week
Omeprazole + amoxicillin + clarithromycin for 1 week Omeprazole + amoxicillin + clarithromycin for 1 week
S. boulardii for 2 weeks
B. subtilis + Enterococcus faecium for 9 weeks
L. acidophilus + L. casei +
B. longum + S. thermophilus for 3 weeks
S. boulardii for 4 weeks L. GG for 1 week C = controlled; DB = double-blind; O = open; P = placebo-controlled; R = randomised.
(L. GG or S. boulardii or a combination of L. acidophilus and B. lactis),68 the third used a Lactobacillus- and Bifidobacterium-containing yoghurt69 and finally Nista-administered B. clausii.71
All found that probiotics were
superior to placebo for the prevention of side effects such as diarrhoea, nausea and unpleasant taste. Furthermore, in a double-blind, randomised, placebo-controlled study performed in 338 volunteers, Myllyluoma found that probiotic supplementation significantly alleviates H. pylori-treatment-associated symptoms;74
in fact, the probiotic
therapy, consisting of four different strains (L. GG, L. rhamnosus LC, P. freudenreichii spp. shermanii Js, B. breve Bb99), reduced the total
EUROPEAN GASTROENTEROLOGY & HEPATOLOGY REVIEW
symptom score, which took into account both the frequency and the severity of gastrointestinal symptoms. In a recent study, a standard triple therapy was supplemented with a wide range of probiotics (L. plantarum, L. reuteri, L. casei ssp. rhamnosus, B. infantis and B. longum, L. salivarius, L. acidophilus, S. thermophilus and L. sporogenes) and with bovine lactoferrin in 206 H. pylori-positive patients.83
The authors obtained a significant difference in side-effect occurrence, such as nausea, diarrhoea, metallic taste, abdominal pain and glossitis, in patients receiving probiotics compared with the placebo group and, interestingly, they observed an increased eradication rate,
125 45/48 23/34 34/42 22/32 3.5 1 44/62 147/176 133/168 37/62 129/176 129/179 1.6 1.8 1.5
L. casei ssp. casei for 10 days
33/35
L. GG + L. rhamnosus LC + 21/23 P. freudenreichii JS,
B. lactis Bb12 for 4 weeks
B. longum + L . acidophilus + Faecal streptococci L. casei for 1 week
B. animalis + L. casei for 3 months
L. reuteri for 20 days 62/64 33/39 15/33 17/20 59/64 27/47 12/32 16/20 2.7 4 1.4 1.4 30/35 19/24 2.7 2.6 L. acidophilus for 10 days L. GG for 2 weeks L. GG for 2 weeks L. GG, S. boulardii,
L. acidophilus + B. lactis for 3 weeks
Lactobacillus + Bifidobacterium 73/80 for 5 weeks
C. butyricum for 1 week B. clausii for 2 weeks 44/47 39/54 63/80 44/50 37/52 2.8 2 1 Probiotic Regimen Eradication Rate
in Probiotic Group in Control Group 52/60
42/60 25/30 48/60 51/64 24/30 46/60 16/21 2.8 1.2 1.2 1.2
Eradication Rate Odds Ratio
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