Efficacy of fermented milk and whey proteins in Helicobacter pylori eradication: A review

Table 3 Clinical trials comparing fermented milk based probiotic preparations vs plain fermented milk

Ref.	Type of trial	Evidence grade1	Quality rating2	Subjects	Study design	Study groups/ methods	Outcome variable/s	Results and conclusions
Positive
Pantoflickova et al[39], 2003, Switzerland	Human	1-	++	50 H. pylori positive healthy volunteers	RCT	Two groups- fermented milk with LC (n = 25) vs fermented milk as Placebo (n = 25). Subjects took the treatment twice daily during the first 3 wk and once daily for the next 13 wk	Effect of LC1 intake without antibiotics on H. pylori gastritis, H. pylori density	LC1 intake had a favorable, albeit weak, effect on H. pylori associated gastritis, particularly in the antrum. Regular ingestion of fermented milk containing L.johnsonii may reduce the risk of developing disorders associated with high degrees of gastric inflammation and mucus depletion	Placebo intake led to a decrease in severity and activity of gastritis in the antrum (inflammatory cell score after 3-wk and 16 wk consumption: 6.3 ± 0.7 and 6.4 ± 1.0, respectively). In the placebo group, mucus depletion scores remained at the same level during the whole duration of the study. H. pylori density decreased in 38% of subjects after 3 wk and 50% after 16 wk
Horie et al[40], 2004, Japan, South Korea, Egypt	Human	1-	-	42 subjects with H. pylori infection	CCT	Two groups- A- test group (yogurt containing 1, 5 g of egg yolk IgY-urease 3 times daily) (n = 22), B- control group (IgY-urease free yogurt) (n = 20)	Effect of IgY-Urease drinking yogurt on C-UBT values	TG showed a reduction in UBT values from 51.18 ± 3.40 at wk 0 to 33.70 ± 3.50 and 31.03 ± 3.54 at 2 and 4 wk resp. Suppression of H. pylori infection in humans could be achieved by consumption of drinking yogurt fortified with IgY-urease	CG showed some decrease in UBT values from 51.40 ± 4.48 to 44.38 ± 5.17 and 43.53 ± 5.48 at 0, 2 and 4 wk, resp. There was no significant difference obtained at week 0 and weeks 2 or 4
Sakamoto et al[41], 2001, Japan	Human	2-		31 subjects infected with H. pylori infection	CT	The study was conducted in two parts. 1st part = 90 g of yogurt (0-9 wk). 2nd part = 90 g yogurt containing LG21 (9-18 wk)	Efficacy of Lactobacillus gasseri OLL2716 (LG21) as a probiotic for Helicobacter pylori	The [13C] urea breath test and assays of serum pepsinogens revealed a significant improvement following LG21 treatment. LG21 was thus determined to be effective in both suppressing H. pylori and reducing gastric mucosal inflammation	There was no significant difference in C-UBT levels at 0 (26.2 ± 15.1) and 9 (26.6 ± 13.7) wk

¹Levels of evidence: 1++ High quality meta-analysis, systematic reviews of RCTs, or RCTs with a very low risk of bias; 1+ Well conducted meta-analysis, systematic reviews of RCTs or RCTs with a low risk of bias; 1- Meta-analysis, systematic reviews or RCTs or RCTs with a high risk of bias; 2++ High quality systematic reviews of case-control or cohort studies or high quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal; 2+ Well conducted case control or cohort studoes with a low risk of confounding, bias, or chance and a significant risk that the relationship is not causal; 3 Non-analytic studies, e.g., case reports, case series; 4 Expert opinion.

²Quality rating for individual studies: ++ Applies if all or most criteria from the checklist are fulfilled; where criteria are not fulfilled the conclusions of the study or review are thought very unlikely to alter; + Applies if some of the criteria from the checklist are fulfilled; where criteria are not fulfilled or are not adequately described, the conclusions of the study or review are thought unlikely to alter; - Applies if few or no criteria from the checklist are fulfilled; where criteria are not fulfilled or are not adequately described, the conclusions of the study or review are thought likely or very likely to alter. H. pylori: Helicobacter pylori; RCT: Randomised controlled trial; CCT: Controlled clinical trial; CT: Clinical trial; C-UBT:

¹³C-urea breath test.