Lactobacillus-containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis.

BACKGROUND Helicobacter pylori infection is recognized as a major contributory factor to many diseases, but recommended eradication therapies demonstrated unsatisfactory eradication rates. Currently, some studies suggested that lactobacillus species have an inhibitory action on Helicobacter pylori both in vitro and in vivo. OBJECTIVE this meta-analysis broadly examined the efficacy of eradication regimens supplemented with lactobacillus-containing probiotic on eradication rates and side effects. METHODS eligible articles were identified by comprehensive searches. Statistical analysis was performed with Review Manager 5.2. Outcomes were finally evaluated according to GRADE system. RESULTS nine randomized controlled trials of high-quality met eligible criteria. Risk ratio of eradication was available for 1,163 patients. Lactobacillus-containing probiotics significantly increased the eradication rate compared with the control group based upon intention-to-treat analysis [RR = 1.14; 95%CI (1.06-1.22); number needed to treat (NNT) = 10] by the fixed effect model without significant publication bias, but no significant reduction associated with overall side effects was observed [RR = 0.88; 95%CI (0.73- 1.06)]. In the subgroup analysis, eradication rates raised significantly by 17% in lactobacillus administrated alone group [RR = 1.25; 95%CI (1.13-1.37); NNT = 6]. In multistrain probiotics group, eradication rates enhanced only 2.8% [RR = 1.04; 95%CI (0.94-1.14)]. It also showed that lactobacillus-containing probiotics improved the eradication rates, respectively, both in adults [RR = 1.12; 95%CI (1.04-1.20); NNT = 12] and in children [RR = 1.25; 95%CI (1.01-1.53); NNT = 7]. CONCLUSIONS Lactobacillus-containing probiotic as an adjunct is effective to eradication therapy, while side effects caused by eradication treatment may not decrease. Furthermore, lactobacillus administrated alone will distinctly benefit eradication therapy.