Vivek Mishra, Debabrata Dash, Aditya K. Panda, Sushil Kumar Pathak
{"title":"补充乳酸杆菌根除幽门螺杆菌的功效:一项随机对照试验的系统荟萃分析。","authors":"Vivek Mishra, Debabrata Dash, Aditya K. Panda, Sushil Kumar Pathak","doi":"10.1111/hel.70006","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p><i>Helicobacter pylori</i> infection is a major global health concern and has been associated with a number of gastrointestinal disorders. Probiotics, especially <i>Lactobacillus</i> spp., have been suggested to have beneficial effect in managing <i>H. pylori</i> infection. This meta-analysis of randomized control trials (RCTs) aimed to evaluate the effect of <i>Lactobacillus</i> spp. supplementation on <i>H. pylori</i> eradication rates and associated side effects when combined with standard therapy.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>Relevant studies were retrieved from PubMed, Scopus, Google Scholar and the Cochrane Library. Comprehensive Meta-Analysis (CMA) Software 4.0 was used for all the statistical analyses. TSA 0.9.5.10 Beta software was used for the trial sequential analysis (TSA). GRADEpro GDT was used to assess the certainty of evidence.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>An analysis of 26 selected studies showed that supplementing with <i>Lactobacillus</i> spp. significantly increased the rates of <i>H. pylori</i> eradication in per-protocol (PP) analysis (Overall risk ratio [RR] = 1.063, <i>p</i> = 0.000, 95% CI of −0.21 to 2.11; adults: RR = 1.050, <i>p</i> = 0.005, 95% CI = −0.55 to 2.03, children: RR = 1.223, <i>p</i> = 0.001, 95% CI = −13.35 to 4.55). In comparison to quadruple therapy, <i>Lactobacillus</i> spp. supplementation to triple therapy showed significant benefit (RR: 1.124; <i>p</i> = 0.000, 95% CI of −0.48 to 2.61). <i>L. reuteri</i> supplementation indicated better efficacy (RR: 1.049; <i>p</i> = 0.055, 95% CI of −0.56 to 3.26) than <i>Lactobacillus</i> GG (RR: 0.980; <i>p</i> = 0.595, 95% CI of −0.69 to 1.21). The 28–30 day (RR: 1.103; <i>p</i> = 0.003, 95% CI of −2.14 to 4.19) and 14-day supplementation periods (RR: 1.102; p = 0.003, 95% CI of −1.69 to 3.51) showed the most improvement. The analysis also revealed that <i>Lactobacillus</i> spp. significantly reduced gastrointestinal side effects: nausea/vomiting (RR: 0.566; <i>p</i> = 0.037, −3.11 to 1.45), diarrhea (RR: 0.324; <i>p</i> = 0.000, −5.46 to 0.48), and abdominal pain (RR: 0.438; <i>p</i> = 0.007, −5.65 to 4.22). The effect on bloating was non-significant (RR: 0.820; <i>p</i> = 0.498, −4.01 to 0.96). TSA graphs validated sufficient evidence for the conclusions.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p><i>Lactobacillus</i> spp. significantly enhances <i>H. pylori</i> eradication rates and may reduce gastrointestinal side effects when used alongside standard therapy, offering a promising adjunctive treatment option. The evidence was supported by TSA and assessed using GRADEpro, indicating a high certainty of the findings.</p>\n </section>\n </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"29 6","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis\",\"authors\":\"Vivek Mishra, Debabrata Dash, Aditya K. Panda, Sushil Kumar Pathak\",\"doi\":\"10.1111/hel.70006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p><i>Helicobacter pylori</i> infection is a major global health concern and has been associated with a number of gastrointestinal disorders. Probiotics, especially <i>Lactobacillus</i> spp., have been suggested to have beneficial effect in managing <i>H. pylori</i> infection. This meta-analysis of randomized control trials (RCTs) aimed to evaluate the effect of <i>Lactobacillus</i> spp. supplementation on <i>H. pylori</i> eradication rates and associated side effects when combined with standard therapy.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and Methods</h3>\\n \\n <p>Relevant studies were retrieved from PubMed, Scopus, Google Scholar and the Cochrane Library. Comprehensive Meta-Analysis (CMA) Software 4.0 was used for all the statistical analyses. TSA 0.9.5.10 Beta software was used for the trial sequential analysis (TSA). GRADEpro GDT was used to assess the certainty of evidence.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>An analysis of 26 selected studies showed that supplementing with <i>Lactobacillus</i> spp. significantly increased the rates of <i>H. pylori</i> eradication in per-protocol (PP) analysis (Overall risk ratio [RR] = 1.063, <i>p</i> = 0.000, 95% CI of −0.21 to 2.11; adults: RR = 1.050, <i>p</i> = 0.005, 95% CI = −0.55 to 2.03, children: RR = 1.223, <i>p</i> = 0.001, 95% CI = −13.35 to 4.55). In comparison to quadruple therapy, <i>Lactobacillus</i> spp. supplementation to triple therapy showed significant benefit (RR: 1.124; <i>p</i> = 0.000, 95% CI of −0.48 to 2.61). <i>L. reuteri</i> supplementation indicated better efficacy (RR: 1.049; <i>p</i> = 0.055, 95% CI of −0.56 to 3.26) than <i>Lactobacillus</i> GG (RR: 0.980; <i>p</i> = 0.595, 95% CI of −0.69 to 1.21). The 28–30 day (RR: 1.103; <i>p</i> = 0.003, 95% CI of −2.14 to 4.19) and 14-day supplementation periods (RR: 1.102; p = 0.003, 95% CI of −1.69 to 3.51) showed the most improvement. The analysis also revealed that <i>Lactobacillus</i> spp. significantly reduced gastrointestinal side effects: nausea/vomiting (RR: 0.566; <i>p</i> = 0.037, −3.11 to 1.45), diarrhea (RR: 0.324; <i>p</i> = 0.000, −5.46 to 0.48), and abdominal pain (RR: 0.438; <i>p</i> = 0.007, −5.65 to 4.22). The effect on bloating was non-significant (RR: 0.820; <i>p</i> = 0.498, −4.01 to 0.96). TSA graphs validated sufficient evidence for the conclusions.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p><i>Lactobacillus</i> spp. significantly enhances <i>H. pylori</i> eradication rates and may reduce gastrointestinal side effects when used alongside standard therapy, offering a promising adjunctive treatment option. The evidence was supported by TSA and assessed using GRADEpro, indicating a high certainty of the findings.</p>\\n </section>\\n </div>\",\"PeriodicalId\":13223,\"journal\":{\"name\":\"Helicobacter\",\"volume\":\"29 6\",\"pages\":\"\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-12-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Helicobacter\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/hel.70006\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Helicobacter","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hel.70006","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis
Background
Helicobacter pylori infection is a major global health concern and has been associated with a number of gastrointestinal disorders. Probiotics, especially Lactobacillus spp., have been suggested to have beneficial effect in managing H. pylori infection. This meta-analysis of randomized control trials (RCTs) aimed to evaluate the effect of Lactobacillus spp. supplementation on H. pylori eradication rates and associated side effects when combined with standard therapy.
Materials and Methods
Relevant studies were retrieved from PubMed, Scopus, Google Scholar and the Cochrane Library. Comprehensive Meta-Analysis (CMA) Software 4.0 was used for all the statistical analyses. TSA 0.9.5.10 Beta software was used for the trial sequential analysis (TSA). GRADEpro GDT was used to assess the certainty of evidence.
Results
An analysis of 26 selected studies showed that supplementing with Lactobacillus spp. significantly increased the rates of H. pylori eradication in per-protocol (PP) analysis (Overall risk ratio [RR] = 1.063, p = 0.000, 95% CI of −0.21 to 2.11; adults: RR = 1.050, p = 0.005, 95% CI = −0.55 to 2.03, children: RR = 1.223, p = 0.001, 95% CI = −13.35 to 4.55). In comparison to quadruple therapy, Lactobacillus spp. supplementation to triple therapy showed significant benefit (RR: 1.124; p = 0.000, 95% CI of −0.48 to 2.61). L. reuteri supplementation indicated better efficacy (RR: 1.049; p = 0.055, 95% CI of −0.56 to 3.26) than Lactobacillus GG (RR: 0.980; p = 0.595, 95% CI of −0.69 to 1.21). The 28–30 day (RR: 1.103; p = 0.003, 95% CI of −2.14 to 4.19) and 14-day supplementation periods (RR: 1.102; p = 0.003, 95% CI of −1.69 to 3.51) showed the most improvement. The analysis also revealed that Lactobacillus spp. significantly reduced gastrointestinal side effects: nausea/vomiting (RR: 0.566; p = 0.037, −3.11 to 1.45), diarrhea (RR: 0.324; p = 0.000, −5.46 to 0.48), and abdominal pain (RR: 0.438; p = 0.007, −5.65 to 4.22). The effect on bloating was non-significant (RR: 0.820; p = 0.498, −4.01 to 0.96). TSA graphs validated sufficient evidence for the conclusions.
Conclusion
Lactobacillus spp. significantly enhances H. pylori eradication rates and may reduce gastrointestinal side effects when used alongside standard therapy, offering a promising adjunctive treatment option. The evidence was supported by TSA and assessed using GRADEpro, indicating a high certainty of the findings.
期刊介绍:
Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.