Effects of probiotic addition to standard treatment of Helicobacter pylori on eradication success and side effect profile

Year 2024, Volume: 7 Issue: 4, 366 - 370, 30.07.2024

Ece Yiğit Gökhan Yılmaz

https://doi.org/10.32322/jhsm.1460718

Abstract

Aims: To reveal the effect of probiotics added to standard Helicobacter pylori eradication treatment on the eradication success and side effect profile.
Methods: This is a prospective cross-sectional study that included male and female patients between the ages of 18-65 who presented to internal medicine and general surgery outpatient clinics with dyspeptic complaints and had a positive stool Helicobacter pylori antigen test. The patients were divided into two groups with the first receiving standard treatment consisting of amoxicillin 1000 mg 2x1, clarithromycin 500 mg 2x1, and lansoprazole 30 mg 2x1. In addition to standard treatment, the second group also received a probiotic supplement containing 1.5 billion colony-forming units (CFU) per tablet twice a day. Both groups were treated for 14 days and were called 1 month later for a stool Helicobacter pylori antigen check. In addition, a questionnaire was administered to the patients aiming to determine the presence and severity of common side effects due to antibiotic use. These side effects were determined as epigastric burning, flatulence, diarrhea, nausea and vomiting, bitter taste and retrosternal burning. 0 means none, 1 means mild, 2 means moderate, and 3 means severe. Patients were asked to score the symptoms they felt while using antibiotics according to this scale. The aim was to investigate whether there was a difference between the two groups in terms of eradication success and side effect profile.
Results: The study included 150 patients (87 males and 63 females) with a mean age of 43.37±12.13 (range 23-65). Group 1 consisted of seventy-five patients who received only antibiotic treatment and group 2 consisted of 75 patients who received antibiotic and probiotic treatment. Eradication percentage was 77.33% in the antibiotic group and 85.33% in the antibiotic+probiotic group. On the other hand, the difference between groups was found to be non-significant (p=0.295). The odds ratio for association between treatment and eradication was 1.705 (95% CI: 0.738-3.940, p=0.212). The percentages of epigastric burning, flatulence, diarrhea, and nausea/vomiting were significantly higher in the antibiotic group than in the antibiotic+probiotic group (p<0.001, p<0.001, p<0.001, p=0.002, respectively). No significant differences between treatment groups in terms of bitter taste and retrosternal burning were found (p=0.323, p=0.579, respectively).
Conclusion: Probiotics cannot be an alternative option to antibiotics in the treatment of Helicobacter pylori; however, when used in combination with antibiotics, they can have a synergistic effect by increasing the eradication success and reducing side effects.

Keywords

Helicobacter pylori, gastritis, probiotics, antibiotics

References

• Ozaydin N, Turkyilmaz SA, Cali S. Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-urea breath test. BMC Public Health. 2013;13:1215. doi: 10.1186/1471-2458-13-1215
• Lee YC, Chiang TH, Chou CK, et al. Association between Helicobacter pylori eradication and gastric cancer incidence: a systematic review and meta-analysis. Gastroenterology. 2016; 150(5):1113-1124. doi: 10.1053/j.gastro.2016.01.028
• Kaplan M, Tanoglu A, Duzenli T, Tozun AN. Helicobacter pylori treatment in Turkey: current status and rational treatment options. North Clin Istanb. 2019;7(1):87-94. doi: 10.14744/nci. 2019.62558
• Georgopoulos SD, Xirouchakis E, Martinez Gonzalez B, et al. Clinical evaluation of a ten day regimen with esomeprazole, metronidazole, amoxicillin, and clarithromycin for the eradication of Helicobacter pylori in a high clarithromycin resistance area. Helicobacter. 2013;18(6):459-467. doi.org/10. 1111/hel.12062
• Sánchez B, Delgado S, Blanco Míguez A, Lourenço A, Gueimonde M, Margolles A. Probiotics, gut microbiota, and their influence on host health and disease. Mol Nutr Food Res. 2017;61(1):1600240. doi: 10.1002/mnfr.201600240
• Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-239. doi: 10.1038/ajg.2016.563
• Wilhelm SM, Johnson JL, Kale-Pradhan PB. Treating bugs with bugs: the role of probiotics as adjunctive therapy for Helicobacter pylori. Ann Pharmacother. 2011;45(7-8):960-966. doi.org/10. 1345/aph.1Q10
• Ianiro G, Tilg H, Gasbarrini A. Antibiotics as deep modulators of gut microbiota: between good and evil. Gut. 2016;65(11):1906-1915. doi.org/10.1136/gutjnl-2016-312297
• Lu C, Sang J, He H, et al. Probiotic supplementation does not improve eradication rate of Helicobacter pylori infection compared to placebo based on standard therapy: a meta-analysis. Scientific Reports. 2016;6(1):23522. doi: 10.1038/srep23522
• Oh B, Kim BS, Kim JW, et al. The effect of probiotics on gut microbiota during the Helicobacter pylori eradication: randomized controlled trial. Helicobacter. 2016;21(3):165-174. doi: 10.1111/hel.12270
• Demir E, Kılıç GB, Özbalcı D. Probiyotiklerin biyogüvenilirlik özellikleri “Probiyotikler”. J Sci Food Agric. 2019;7(4):639-645. doi:10.24925/turjaf.v7i4.639-645.2327
• Çekin AH, Şahintürk Y, Akbay Harmandar F, Uyar S, Yolcular BO, Çekin Y. Use of probiotics as an adjuvant to sequential H. pylori eradication therapy: impact on eradication rates, treatment resistance, treatment-related side effects, and patient compliance. Turk J Gastroenterol. 2017;28(1):3-11. doi: 10.5152/tjg.2016.0278
• Özden A, Seven G, Bektaş M. Effectiveness of different treatment regimens in Helicobacter pylori eradication: ten year experience of a single institution. Turk J Gastroenterol. 2010;21(3):218-223. doi: 10.4318/tjg.2010.0091
• Malfertheiner P, Megraud F, O’Morain C, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence consensus report. Gut. 2017;66(1):6-30. doi: 10.1136/gutjnl-2016- 312288
• Ismail NI, Nawawi KN, Hsin DC, et al. Probiotic containing Lactobacillus reuteri DSM 17648 as an adjunct treatment for Helicobacter pylori infection: a randomized, double blind, placebo controlled trial. Helicobacter. 2023;28(6):e13017. doi: 10.1111/hel.13017
• Patel SK, Pratap CB, Jain AK, Gulati AK, Nath G. Diagnosis of Helicobacter pylori: what should be the gold standard? World J Gastroenterol. 2014;20(36):12847. doi: 10.3748/wjg.v20.i36.12847
• Çağlar R. Helicobacter pylori eradikasyonunda kullanılan kombine tedavilerin etkinliklerinin karşılaştırılması. SABD. 2023;13(1):119-122. doi.org/10.33631/sabd.1210607
• Nyssen OP, Perez-Aisa A, Tepes B, et al. Adverse event profile during the treatment of Helicobacter pylori: a real-world experience of 22,000 patients from the European registry on Helicobacter pylori management (Hp-EuReg). Am J Gastroenterol. 2021;116(6):1220-9. doi: 10.14309/ajg.0000000000001246
• Viazis N, Argyriou K, Kotzampassi K, et al. A four-probiotics regimen combined with a standard Helicobacter pylori-eradication treatment reduces side effects and increases eradication rates. Nutrients. 2022;14(3):632. doi.org/10.3390/nu14030632
• Mukai T, Asasaka T, Sato E, Mori K, Matsumoto M, Ohori H. Inhibition of binding of Helicobacter pylori to the glycolipid receptors by probiotic Lactobacillus reuteri. FEMS Microbiol Rev. 2002;32(2):105-110. doi.org/10.1111/j.1574-695X.2002.tb00541.x
• Kafshdooz T, Akbarzadeh A, Seghinsara AM, Nasrabadi HT, Milani M. Role of probiotics in managing of Helicobacter pylori infection: a review. Drug Research. 2017;11(02):88-93. doi: 10.1055/s-0042-116441
• Shi X, Zhang J, Mo L, Shi J, Qin M, Huang X. Efficacy and safety of probiotics in eradicating Helicobacter pylori: a network meta-analysis. Medicine. 2019;98(15):e15180. doi: 10.1097/MD. 0000000000015180
• Akcam M, Koca T, Salman H, Karahan N. The effects of probiotics on treatment of Helicobacter pylori eradication in children. Saudi Med J. 2015;36(3):286-290. doi: 10.15537/smj. 2015.3.10124
• McNicholl AG, Molina-Infante J, Lucendo AJ, et el. Probiotic supplementation with Lactobacillus plantarum and Pediococcus acidilactici for Helicobacter pylori therapy: a randomized, double-blind, placebo-controlled trial. Helicobacter. 2018;23(5):12529. doi: 10.1111/hel.12529
• Goderska K, Agudo Pena S, Alarcon T. Helicobacter pylori treatment: antibiotics or probiotics. Appl Microbiol Biotechnol. 2018;102:1-7. doi: 10.1007/s00253-017-8535-7