Meta‐analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy

Systematic review and meta-analysis of 14 randomized controlled trials in people with Helicobacter pylori infection receiving eradication therapy. The included studies enrolled adults and some children from multiple countries, including treatment-naive patients and those with prior eradication failure; eradication was assessed at least 4 weeks after therapy.

Probiotic supplementation was added to standard anti-Helicobacter pylori eradication therapy, with regimens including Bacillus clausii, Lactobacillus rhamnosus GG, Saccharomyces boulardii, Lactobacillus acidophilus, Lactobacillus acidophilus LB, and AB-yogurt containing live organisms. Doses and durations varied by trial, commonly given twice daily for 10 to 14 days, or as yogurt-based supplementation for several weeks.

Overall, adding probiotics improved Helicobacter pylori eradication and reduced treatment-related adverse events. Intention-to-treat eradication was higher with probiotics than without them: 83.6% (463 of 554) versus 74.8% (389 of 520), OR 1.84 (95% CI 1.34-2.54); per-protocol eradication was also higher, OR 1.82 (95% CI 1.30-2.56). Total side effects were lower with probiotics: 24.7% versus 38.5%, OR 0.44 (95% CI 0.30-0.66), and diarrhea was reduced from 16.1% to 6.0%, OR 0.34 (95% CI 0.22-0.52). Taste disturbance, nausea, and epigastric pain were also modestly reduced, supporting probiotics as a helpful adjunct during eradication therapy, particularly for patients with prior eradication failure.

The evidence pooled multiple probiotic strains, doses, and treatment durations, which increases clinical heterogeneity and limits strain-specific conclusions. The trials also varied in population type, including adults and children, symptomatic and asymptomatic patients, and both primary and salvage eradication settings. Several arm-level details such as baseline diet, physical activity, and BMI were not consistently reported, and larger more diverse trials are still needed to identify optimal products and patient groups.