Efficacy of Lactobacillus reuteri supplementation therapy for Helicobacter pylori eradication: A meta-analysis of randomised controlled trials

Abstract

Aims

To investigate the effects of Lactobacillus reuteri supplementation on the eradication rate of H. pylori and the treatment-related adverse effects caused by anti-H. pylori therapies.

Methods

The authors conducted independent searches of PubMed, Medline, Embase and Cochrane library from the inception of this study until May 2021 and extracted data from eligible randomised controlled trials published in English that compared Lactobacillus reuteri supplementation to placebo or no treatment during anti-H. pylori therapies. Review Manager 5.3 was used for all statistical analyses.

Results

Six randomized controlled trials involving 378 patients were included in the analysis. An intention-to-treat analysis via a fixed-effects model showed that the pooled relative risk (RR) for the eradication rate was higher for the Lactobacillus reuteri supplementation group than for the control group, but the difference was not significant [RR 1.12, 95% confidence interval (CI): 0.98–1.27, P ​= ​0.09). The incidence of total antibiotic-related side effects was lower in the Lactobacillus reuteri supplementation group than in the control group, with a pooled RR value of 0.55 (95% CI: 0.39–0.77, P ​= ​0.0006), which was determined using a fixed-effects model. Certain adverse events, such as diarrhoea (RR ​= ​0.31, 95% CI: 0.19–0.52, P ​< ​0.00001), abdominal pain (RR ​= ​0.71, 95% CI: 0.55–0.93, P ​= ​0.01) and constipation (RR ​= ​0.45, 95% CI: 0.25–0.83, P ​= ​0.01), were reported at lower rates in the Lactobacillus reuteri supplementation group than in the control group.

Conclusion

Lactobacillus reuteri supplementation during anti-Helicobacter pylori treatment may not be effective for improving H. pylori eradication rates. However, it can minimize the incidence of therapy-related adverse events and alleviate most disease-related symptoms. Our results should be interpreted with caution due to the lack of enough trials included in this analysis.