Efficacy of probiotics regimens for Helicobacter pylori eradication: A systematic review, pairwise, and network meta-analysis of randomized controlled trials

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-02-01 DOI:10.1016/j.clnesp.2024.11.016

Mohammad Tanashat , Mohamed Abuelazm , Mohamed Abouzid , Yazan A. Al-Ajlouni , Alaa Ramadan , Sumaya Alsalah , Abdulrahman Sharaf , Dina Ayman , Hesham Elharti , Sara Zhana , Obieda Altobaishat , Basel Abdelazeem , Fouad Jaber

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引用次数: 0

Abstract

Background

Helicobacter pylori (H. pylori) infection increases the risks of chronic gastritis, peptic ulcer diseases, and the incidence of gastric cancer. However, antibiotic resistance and adverse effects led to the emergence of alternative treatments such as probiotics supplementation. This systematic review and network meta-analysis aims to assess the efficacy and safety of incorporating probiotics into the various eradication regimens for H. pylori.

Methods

We searched PubMed, Embase, Scopus, Cochrane, and Web of Science from inception to May 2023, for randomized controlled trials (RCTs) comparing standard therapy (triple or quadrable therapy). for H. pylori with or without probiotic supplementation. Dichotomous data was reported using an odds ratio (OR) for intention-to-treat (ITT) and risk ratios (RR) for side effects with a 95 % confidence interval (CI).

Results

We included 91 RCTs involving 13,680 patients. Adding probiotics to standard treatment was associated with a higher H. pylori eradication rate in the ITT analysis (78.75 % vs 62.43 %, OR = 1.62, 95 % CI: 1.41 to 1.87, P < 0.0001), and per-protocol (PP) analysis (80.33 % vs 72.63 %, OR = 1.60, 95 % CI: 1.34 to 1.91, P < 0.0001). Meanwhile, dyspepsia, gastric ulcer, and peptic ulcer were comparable in both groups. The probiotics group was associated with significantly fewer side effects including, abdominal pain (RR = 0.68, 95 % CI: 0.54 to 0.86), bad taste (RR = 0.64, 95 % CI: 0.53 to 0.78), diarrhea (RR = 0.49, 95 % CI: 0.40 to 0.61), epigastric pain/bloating (RR = 0.76, 95 % CI: 0.65 to 0.88), headache/dizziness (RR = 0.46, 95 % CI: 0.29 to 0.74), (RR = 0.65, 95 % CI: 0.55 to 0.77), or nausea/vomiting (RR = 0.69, 95 % CI: 0.56 to 0.83). The network meta-analysis showed that, compared to the placebo, Bifidobacterium longum had the highest efficacy in eradicating H. pylori (ITT: 81.06 % vs 64.88 %, PP: 88 % vs 75.71 %) (OR = 2.52, 95 % CI: 1.18 to 5.49).

Conclusion

Adding probiotics to standard H. pylori therapy not only increased the rate of eradication but also reduced some of the adverse reactions throughout therapy, particularly nausea, vomiting, diarrhea, abdominal pain, epigastric pain/bloating, and taste issues.

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益生菌方案根除幽门螺杆菌的疗效：随机对照试验的系统评价，两两和网络荟萃分析。

背景：幽门螺杆菌感染可增加慢性胃炎、消化性溃疡疾病和胃癌的发病率。然而，抗生素耐药性和不良反应导致了益生菌补充等替代治疗的出现。本系统综述和网络荟萃分析旨在评估将益生菌纳入各种幽门螺杆菌根除方案的有效性和安全性。方法：我们检索了PubMed、Embase、Scopus、Cochrane和Web of Science从成立到2023年5月的随机对照试验（rct），比较标准疗法（三联疗法或四联疗法）。有无补充益生菌的幽门螺杆菌使用治疗意向的比值比（OR）和副作用的风险比（RR）报告二分数据，其置信区间为95%。结果：我们纳入91项随机对照试验，涉及13680例患者。在标准治疗中添加益生菌与意向治疗(ITT0分析（78.75% vs 62.43%， OR= 1.62, 95% CI: 1.41 ~ 1.87, P < 0.0001）和按方案（PP）分析（80.33% vs 72.63%， OR= 1.60, 95% CI: 1.34 ~ 1.91, P < 0.0001）中较高的幽门螺杆菌根除率相关。同时，两组的消化不良、胃溃疡和消化性溃疡具有可比性。益生菌组的副作用显著减少，包括腹痛（RR= 0.68, 95% CI: 0.54至0.86）、味觉不良（RR=0.64, 95% CI: 0.53至0.78）、腹泻（RR= 0.49, 95% CI: 0.40至0.61）、胃脘痛/腹胀（RR= 0.76, 95% CI: 0.65至0.88）、头痛/头晕（RR=0.46, 95% CI: 0.29至0.74）、（RR=0.65, 95% CI: 0.55至0.77）或恶心/呕吐（RR= 0.69, 95% CI: 0.56至0.83）。网络荟萃分析显示，与安慰剂相比，长双歧杆菌根除幽门螺杆菌的效果最高（ITT: 81.06% vs 64.88%, PP: 88% vs 75.71%）（OR= 2.52, 95% CI: 1.18 ~ 5.49）。结论：在标准幽门螺杆菌治疗中添加益生菌不仅提高了根除率，而且减少了整个治疗过程中的一些不良反应，特别是恶心、呕吐、腹泻、腹痛、胃脘痛/腹胀和味觉问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.