The Effect Of Drug Based Probiotic Preparations During Helicobacter Pylori Eradication Therapy:a Meta-analysis

BACKGROUND Helicobacter pylori (Hp) is one of the most common pathogens infecting about half of the world’s population, which has been confirmed as a key risk factor for developing chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and mucosa associated lymphoid tissue lymphoma. To manage these Hp-related diseases, it is important to formulate an effective Hp eradication treatment. However, the Hp eradication rates of antibiotic therapy are decreasing over time due to the increase in antibiotic resistance and the patient non-compliance. Recent studies have shown that the drug based probiotic preparations could increase the eradication rates and/or reduce the side effects. However, the results of some other clinical trials were not consistent.OBJECTIVES This Meta-analysis aims to systematically evaluate the effect of drug based probiotic preparations supplementation on eradication rates and side effects during anti-Hp treatment.METHODS A systematic literature search of PubMed, EMBASE, Cochrane Library and Chinese Biomedical Database was conducted using specific search terms. Eligible studies were randomized controlled trials comparing drug based probiotic preparations supplementation or not during anti-Hp regimens. The outcomes were Hp eradication rates, the incidence of total side effects and the incidence of individual side effects. We calculated the relative risk (RR) with corresponding 95% confidence intervals (CIs) by using the STATA version 12.0 software. Subgroup analysis and sensitivity analysis were also performed. Publication bias was assessed with funnel plots, and asymmetry was tested by Begg’s rank correlation and Egger’s weighted regression.RESULTS Fifteen RCTs involving a total of 2451 patients met the inclusion criteria. Of these studies, all 15 reported Hp eradication rates as primary outcome, and 13 reported the incidence of total side effects. The eradication rate for patients with probiotic was significantly higher than those without proibiotic. The pooled RR were 1.13,95%CI(1.08,1.19) by intention-to-treat analysis and 1.10,95%CI(1.05,1.15) by per-protocol analysis. The incidence of total side effects was significantly lower in the probiotic group than in the control group. The pooled RR was 0.62,95% CI(0.48,0.80). The incidences of diarrhea and nausea/vomiting were significantly reduced for patients with probiotic supplementation. The pooled RR were 0.37,95%CI(0.25,0.55) and 0.57,95%CI(0.37,0.88). The incidences of epigastric/abdominal pain and constipation did not differ significantly between groups. The pooled RR were 1.12,95%CI(0.35,3.51) and 0.29,95%CI(0.06,1.36).CONCLUSION Drug based probiotic preparations supplementation during initial anti-Hp treatment in the adult may increase the eradication rate and have beneficial effects on the incidence of side effects, especially for diarrhea and nausea/vomiting. More studies with rigorous designs, high quality, large sample sizes, and multiregional cooperation are required to obtain further evidence of the efficacy of probiotics in Hp eradication therapies.