Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 139-149
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.139
Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis
Giuseppe Losurdo, Rossella Cubisino, Michele Barone, Mariabeatrice Principi, Gioacchino Leandro, Enzo Ierardi, Alfredo Di Leo
Giuseppe Losurdo, Rossella Cubisino, Michele Barone, Mariabeatrice Principi, Enzo Ierardi, Alfredo Di Leo, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
Gioacchino Leandro, National Institute of Gastroenterology, “S De Bellis” Research Hospital, Via Turi, Castellana Grotte (BA) 70013, Italy
Author contributions: Losurdo G, Leandro G, Ierardi E and Di Leo A conceived the study; Losurdo G, Cubisino R, Barone M and Principi M collected the data; Losurdo G and Leandro G performed the statistical analysis; Losurdo G, Cubisino R and Ierardi E wrote the manuscript; All authors revised the manuscript and approved the final version.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Enzo Ierardi, MD, Professor, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare 11, Bari 70124, Italy.
Telephone: +39-80-5593452 Fax: +39-80-5593088
Received: October 7, 2017
Peer-review started: October 9, 2017
First decision: October 25, 2017
Revised: November 13, 2017
Accepted: November 21, 2017
Article in press: November 21, 2017
Published online: January 7, 2018
Research background

Probiotics have been largely used as adjunctive treatment for Helicobacter pylori (H. pylori) eradication, showing good results.

Research motivation

Until now, meta-analyses have investigated probiotic effects on H. pylori only in association with antibiotics. Therefore, our aim was to perform a systematic review with pooled data analysis regarding this uninvestigated topic.

Research objectives

The objective was to perform a meta-analysis aiming to calculate a pooled eradication rate for probiotic monotherapy, overall and according to the strain.

Research methods

Article search and selection was conducted according to the PRISMA criteria. We performed a pooled-data analysis using to the inverse variance method to calculate the mean weighted eradication rate. Peto odd ratio (OR) was calculated for the comparison “probiotics vs placebo”. For continuous variables (delta value of urea breath test), we entered mean, standard deviations and sample size in order to calculate the weighted mean difference.

Research results

We found that probiotic monotherapy may eradicate H. pylori in 14% of cases. Lactobacilli, Saccharomyces boulardii and multistrain combinations eradicated the bacterium with a rate of 16%, 12% and 14%, respectively. Probiotics were significantly more effective than placebo (OR = 7.91). Moreover, probiotics were able to reduce delta values in the expirate of urea breath test.

Research conclusions

The eradication rate of probiotics’ monotherapy is disappointing; however, our meta-analysis showed that, in some cases, they are able to defeat the bacterium. They compete with H. pylori for host surface receptors and, thereby, inhibit its adhesion to epithelial cells. Furthermore, it has been demonstrated that probiotics could hamper H. pylori urease activity. On these bases, since probiotics administration does not carry the risk of antibiotic resistance, it could represent an optimal strategy in selected cases.

Research perspectives

Further studies on large sample size are necessary to draw more solid conclusions about a direct inhibitory effect of probiotics on H. pylori.