Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Helicobacter Pub Date : 2024-12-25 DOI:10.1111/hel.70006

Vivek Mishra, Debabrata Dash, Aditya K. Panda, Sushil Kumar Pathak

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Abstract

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.

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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。

背景：幽门螺杆菌感染是一个主要的全球健康问题，并与许多胃肠道疾病有关。益生菌，尤其是乳杆菌，被认为对控制幽门螺杆菌感染有有益的作用。这项随机对照试验（rct）的荟萃分析旨在评估补充乳酸杆菌与标准治疗联合使用时对幽门螺杆菌根除率和相关副作用的影响。材料和方法：相关研究检索自PubMed、Scopus、谷歌Scholar和Cochrane Library。采用综合meta分析软件4.0进行统计分析。采用TSA 0.9.5.10 Beta软件进行试验序列分析（TSA）。GRADEpro GDT用于评估证据的确定性。结果：对选定的26项研究的分析显示，在per-protocol （PP）分析中，添加乳酸杆菌可显著提高幽门螺杆菌根除率(总风险比[RR] = 1.063, p = 0.000, 95% CI为-0.21 ~ 2.11；成人:RR = 1.050, p = 0.005, 95% CI = -0.55至2.03,孩子:RR = 1.223, p = 0.001, 95% CI = -13.35 - 4.55)。与四联疗法相比，三联疗法中添加乳酸杆菌具有显著的益处(RR: 1.124；p = 0.000, 95% CI为-0.48 ~ 2.61)。补充罗伊氏乳杆菌效果更好(RR: 1.049；p = 0.055, 95% CI为-0.56 ~ 3.26)比乳酸菌GG (RR: 0.980；p = 0.595, 95% CI为-0.69 ~ 1.21)。28 ~ 30天(RR: 1.103；p = 0.003, 95% CI为-2.14 ~ 4.19)和14天的补充期(RR: 1.102；p = 0.003, 95% CI为-1.69 ~ 3.51)，改善最大。分析还显示，乳杆菌可显著减少胃肠道副作用：恶心/呕吐(RR: 0.566；p = 0.037, -3.11 ~ 1.45)，腹泻(RR: 0.324；p = 0.000, -5.46 ~ 0.48)，腹痛(RR: 0.438；P = 0.007, -5.65至4.22)。对腹胀无显著影响(RR: 0.820；P = 0.498, -4.01至0.96)。运输安全管理局的图表证实了结论的充分证据。结论：乳酸菌可显著提高幽门螺杆菌的根除率，并可减少胃肠道副作用，与标准治疗一起使用，是一种有希望的辅助治疗选择。这些证据得到了TSA的支持，并使用GRADEpro进行了评估，表明研究结果具有很高的确定性。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

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.