Helicobacter pylori infection in clinical practice: probiotics and a combination of probiotics + lactoferrin improve compliance, but not eradication, in sequential therapy.
ABSTRACT Sequential therapy (ST) seems to offer higher success rates than triple therapy (TT) in the eradication of Helicobacter pylori (H. pylori) infection. However, from the standpoint of therapeutic compliance, there is no difference between the two treatments. Adjuvant treatment (especially with probiotics (PB) and lactoferrin (LF)) has often improved compliance and eradication rates in patients subjected to TT, while ST had never been used in association with adjuvants.
Over a period of 2 years, we randomized and divided 227 consecutive adult patients with H. pylori infection into three groups. The patients were given ST with the addition of adjuvants, as follows: group A (ST + placebo), group B (ST + LF + PB), and group C (ST + PB). Our goal was to assess therapeutic compliance, so we prepared a questionnaire to help determine the severity of the side effects. We also determined the eradication rates for the groups.
Patients with ST + placebo had the worst compliance as compared with the other two groups in terms of the absence of symptoms (p < .001 between B and A; p = .001 between C and A) and the presence of intolerable symptoms (p = .016 between B and A; p = .046 between C and A). The differences between the values for the treated groups and those for the placebo group were statistically significant. On the other hand, there was no statistically significant difference in compliance between groups B and C. The eradication rate was similar for the three groups.
Probiotics associated with ST provide optimum therapeutic compliance compared with the placebo and, despite the need to take a larger number of tablets, they should be taken into consideration as an adjuvant to therapy for H. pylori infection. The addition of LF to the PB did not bring about any further improvements in compliance. As compared with the placebo, the eradication rate of ST did not improve by adding LF + PB or by using PB alone.
- SourceAvailable from: Fernando GomollónGastroenterología y Hepatología. 05/2013; 36(5):340–374.
- Gastroenterología y Hepatología 04/2013; · 0.57 Impact Factor
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ABSTRACT: Background: Helicobacter pylori infection is recognized as a major contributory factor to many diseases, but recommended eradication therapies demonstrated unsatisfactory eradication rates. Currently, some studies suggested that lactobacillus species have an inhibitory action on Helicobacter pylori both in vitro and in vivo. Objective: this meta-analysis broadly examined the efficacy of eradication regimens supplemented with lactobacillus -containing probiotic on eradication rates and side effects. Methods: eligible articles were identified by comprehensive searches. Statistical analysis was performed with Review Manager 5.2. Outcomes were finally evaluated according to GRADE system. Results: nine randomized controlled trials of high-quality met eligible criteria. Risk ratio of eradication was available for 1,163 patients. Lactobacillus -containing probiotics significantly increased the eradication rate compared with the control group based upon intention-to-treat analysis [RR = 1.14; 95 %CI (1.06-1.22); number needed to treat (NNT) = 10] by the fixed effect model without significant publication bias, but no significant reduction associated with overall side effects was observed [RR = 0.88; 95 %CI (0.73-1.06)]. In the subgroup analysis, eradication rates raised significantly by 17 % in lactobacillus administrated alone group [RR = 1.25; 95 %CI (1.13-1.37); NNT = 6]. In multistrain probiotics group, eradication rates enhanced only 2.8 % [RR = 1.04; 95 %CI (0.94-1.14)]. It also showed that lactobacillus -containing probiotics improved the eradication rates, respectively, both in adults [RR = 1.12; 95 %CI (1.04-1.20); NNT = 12] and in children [RR = 1.25; 95 %CI (1.01-1.53); NNT = 7]. Conclusions: Lactobacillus -containing probiotic as an adjunct is effective to eradication therapy, while side effects caused by eradication treatment may not decrease. Furthermore, lactobacillus administrated alone will distinctly benefit eradication therapy.Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 09/2013; 105(8):445-453. · 1.65 Impact Factor