Probiotics
Table 4: Summary of Clinical Trials of Probiotics in Helicobacter pylori Infection – Effects on Antibiotic-associated Gastrointestinal Side Effects
Reference and Type of Study Type of Patient Number Eradication Therapy Armuzzi et al., 200166 DB, R, P
Asymptomatic 60 adults
Cremonini et al., 200268 DB, P, R
Sheu et al., 200269 R, P
Nista et al., 200471 DB, R, P
Tursi et al., 200472 O, C
Asymptomatic 85 adults Dyspeptic 160 adults Asymptomatic 120 adults Dyspeptic 70 adults
Myllyluoma et al., 200574 DB, R, P
Duman DG et al., 200584 DB, R, C
Lionetti et al., 200677 DB, R, P
Asymptomatic 47 adults Dyspeptic Dyspeptic 376
adults 40
children
Cindoruk et al., 200778 DB, R, P
Park et al., 200779 DB, R, C
De Bortoli et al., 200783 R
Dyspeptic Dyspeptic Dyspeptic 124
adults 352
adults 206 adults
Rabeprazole + clarithromycin +
tinidazole for 1 week Rabeprazole + clarithromycin +
tinidazole for 1 week Lansoprazole + clarithromycin +
amoxicillin for 1 week Rabeprazole + clarithromycin +
amoxicillin for 1 week Ranitidine bismuth
citrate + esomeprazole +
amoxixillin + tinidazole for 10 days
Lansoprazole + clarithromycin +
amoxicillin for 1 week
Omeprazole + amoxicillin + clarithromycin for 2 weeks Omeprazole, amoxicillin, clarithromycin, tinidazole (sequential therapy) for 10 days
Lansoprazole + amoxicillin + clarithromycin for 2 weeks Omeprazole + amoxicillin + clarithromycin for 1 week
Esomeprazole + clarithromycin +
amoxicillin for 1 week
L. GG + L. rhamnosus LC + Total symptom score P. freudenreichii JS,
B. lactis Bb12 for 4 weeks S. boulardii for 2 weeks
L. reuteri for 20 days significantly decreased in PR
Diarrhoea significantly less in PR
Epigastric pain, abdominal distension, belching, halitosis significantly less in PR
S. boulardii for 2 weeks
B. subtilis + S. faecium for 9 weeks
Diarrhoea, epigastric pain significantly less in PR
Diarrhoea significantly less in PR
L. plantarum + L. reuteri + Diarrhoea, nausea, metallic L. casei ssp. rhamnosus + taste, abdominal pain, B. infantis + B. longum +
glossitis significantly less
Imase et al., 200885 DB, R, C
Kim et al., 200880 DB, R, C
Hurduc et al., 200981 O, R, P
Szajewska et al., 200982 DB, R, P
Peptic ulcer Dyspeptic Dyspeptic Dyspeptic 19
adults 347
adults 90 66
Omeprazole + amoxicillin + clarithromycin for 1 week Omeprazole + amoxicillin + clarithromycin for 1 week
Omeprazole + amoxicillin + children clarithromycin for 1 week Omeprazole + amoxicillin + children clarithromycin for 1 week C = controlled; DB = double-blind; O = open; P = placebo controlled; PR = probiotic group, R = randomised.
probably due to the concomitant use of lactoferrin. Recently, similar results were also reported for L. casei,72 boulardii84
and Clostridium butyricum.85
B. subtilis and S. faecium,79 The rationale for coupling a
S.
probiotic to any antibiotic treatment stems from the results of a recent study showing that daily supplementation with viable probiotic bacteria during and post-antibiotic therapy reduces the extent of disruption to the intestinal microbiota as well as the incidence and total numbers of antibiotic-resistant strains in the re-growth population, suggesting that a probiotic should be always associated with an antibiotic.86
Our group has recently performed the first trial in children to determine whether adding the probiotic L. reuteri to an anti-H. pylori
126
regimen could help to prevent or minimise the gastrointestinal side- effect burden in children.77
L. GG for 1 week
L. salivarius + L. acidophilus in PR + S. thermophilus + L. sporogenes for 1 week C. butyricum for 1 week
Probiotic Regimen L. GG for 2 weeks
L. GG, S. boulardii, L. acidophilus +
B. lactis for 3 weeks Lactobacillus +
B. clausii for 2 weeks
L. casei ssp. casei for 10 days
Results
Diarrhoea, nausea, unpleasant taste,
significantly less in PR
Diarrhoea, unpleasant taste significantly less in all PR groups
Vomiting, constipation,
Bifidobacterium for 5 weeks diarrhoea, unpleasant taste significantly less in PR
Diarrhoea, nausea, epigastric pain significantly less in PR
Diarrhoea, epigastric pain significantly less in PR
Diarrhoea significantly less in PR
L. acidophilus + L. casei + Unpleasant taste significantly
B. longum + S. thermophilus less in controls for 3 weeks
S. boulardii for 4 weeks Overall incidence of side
effects significantly reduced in PR
No significant difference between PR and placebo
Forty H. pylori-positive children were
consecutively treated with 10-day sequential therapy, and at the same time they were blindly randomised to receive either L. reuteri ATCC 55730 (SD2112) or placebo (maltodextrin) for 20 days starting from the first day of the anti-H. pylori regimen. In order to determine the type and severity of side effects, all children completed the GSRS at entry and on day five and 10 of treatment and at follow-up after 20 days. H. pylori status was assessed after eight weeks by 13C-UBT. Overall, in all probiotic-supplemented children compared with those receiving placebo there was a significant reduction in the GSRS score during eradication therapy (4.1±2, 95% CI 2.9–5.9 versus 6.2±3, 95% CI
EUROPEAN GASTROENTEROLOGY & HEPATOLOGY REVIEW
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