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Di Pierro F, Bertuccioli A, Saponara M, Ivaldi L. Impact of a two-bacterial-strain formula, containing Bifidobacterium animalis lactis BB-12 and Enterococcus faecium L3, administered before and after therapy for Helicobacter pylori eradication. MINERVA GASTROENTERO 2020; 66:117-123. [PMID: 32272820 DOI: 10.23736/s1121-421x.19.02651-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Results from the meta-analysis of randomized controlled studies demonstrate that the adjuvant use of probiotics enhances the rate of Helicobacter pylori (Hp) eradication, reducing concomitantly the occurrence of side effects, mainly diarrhea. Bifidobacterium animalis lactis BB-12 and Enterococcus faecium L3 are two bacterial strains reported to clinically improve the rate of Hp eradication, reducing concomitantly the occurrence of side effects. METHODS Due to our pragmatic and routine use of these two strains as an adjuvant therapy to antibiotics and proton pump inhibitors (PPIs) during attempted Hp eradication, we have analyzed retrospectively their impact on the outcome. RESULTS Our results, obtained through a highly pragmatic clinical approach, demonstrate that the probiotic add-on therapy before and after the triple or quadruple therapy to eradicate Hp increases eradication rates and reduces side effects. Moreover, even if observed in only a small cohort of patients, the treatment seems to improve the eubiosis of the gut microbial consortium. CONCLUSIONS Administration of BB-12 and L3 strains as an adjuvant regimen during Hp eradication therapy has better success than conventional therapy (antibiotics plus a PPI) alone.
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Affiliation(s)
| | | | | | - Leandro Ivaldi
- Department of Digestive Endoscopy, Ceva Hospital, Ceva, Cuneo, Italy
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Selig DJ, DeLuca JP, Li Q, Lin H, Nguyen K, Scott SM, Sousa JC, Vuong CT, Xie LH, Livezey JR. Saccharomyces boulardii CNCM I-745 probiotic does not alter the pharmacokinetics of amoxicillin. Drug Metab Pers Ther 2020; 35:/j/dmdi.ahead-of-print/dmpt-2019-0032/dmpt-2019-0032.xml. [PMID: 32134728 DOI: 10.1515/dmpt-2019-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/22/2020] [Indexed: 11/15/2022]
Abstract
Background Probiotics are live microbial organisms that provide benefit to the host while co-habitating in the gastrointestinal tract. Probiotics are safe, available over the counter, and have clinical benefit by reducing the number of antibiotic-associated diarrhea days. Prescriptions from providers and direct consumer demand of probiotics appear to be on the rise. Several recent animal studies have demonstrated that probiotics may have significant effect on absorption of co-administered drugs. However, to date, most probiotic-drug interaction studies in animal models have been limited to bacterial probiotics and nonantibiotic drugs. Methods We performed a traditional pharmacokinetic mouse study examining the interactions between a common commercially available yeast probiotic, Saccharomyces boulardii CNCM I-745 (Florastor®) and an orally administered amoxicillin. Results We showed that there were no significant differences in pharmacokinetic parameters (half-life, area under the curve, peak concentrations, time to reach maximum concentration, elimination rate constant) of amoxicillin between the probiotic treated and untreated control groups. Conclusions Altogether, our findings suggest that coadministration or concurrent use of S. boulardii probiotic and amoxicillin would not likely alter the efficacy of amoxicillin therapy.
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Affiliation(s)
- Daniel J Selig
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA, Phone: (+301) 319-9807, Fax: 301-319-9449
| | - Jesse P DeLuca
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Qigui Li
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Hsiuling Lin
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Ken Nguyen
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Shaylyn M Scott
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Jason C Sousa
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Chau T Vuong
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Lisa H Xie
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
| | - Jeffrey R Livezey
- Walter Reed Army Institute of Research, Experimental Therapeutics Branch, Silver Spring, MD, USA
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Kouitcheu Mabeku LB, Ngue S, Bonsou Nguemo I, Leundji H. Potential of selected lactic acid bacteria from Theobroma cacao fermented fruit juice and cell-free supernatants from cultures as inhibitors of Helicobacter pylori and as good probiotic. BMC Res Notes 2020; 13:64. [PMID: 32041667 PMCID: PMC7011242 DOI: 10.1186/s13104-020-4923-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The present study was designed to evaluate the inhibitory effect of lactic acid bacteria (LAB) isolates from the fermented cocoa juice and their cell-free culture supernatants (CFS) against Helicobacter pylori strains and their potential as good probiotic. Isolation of lactic acid bacteria (LAB) was performed by culture and subculture of sample on MRS agar. Morphological characteristics, Gram staining and catalase reaction were used to identify the isolates. The antagonistic activity of LAB was tested using the agar spot-on-lawn method and the inhibitory effect of CFS using well diffusion assay. Acid tolerance and resistance to antibiotics tests were used to evaluate the probiotic potential of LAB isolates. RESULTS Antagonistic effect was observed in 65.52% of isolated LAB. Isolate LAB19 showed the broader spectrum of antagonistic effect. The overall inhibitory activity was two to three folds reduced when CFSs were used instead of LAB isolates themselves. Our data showed that LAB19 controlled H. pylori growth using bacteriocins and that LAB4', LAB8, LAB11', LAB12, LAB13', LAB15, LAB16 and LAB17 were through organic acids. LAB9, LAB11' and LAB12 showed properties of probiotic tested. In this study, nine LAB isolates were found to possess anti-Helicobacter activity and some preliminary probiotic properties.
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Affiliation(s)
- Laure Brigitte Kouitcheu Mabeku
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67 Dschang, Cameroon
| | - Samuel Ngue
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67 Dschang, Cameroon
| | - Idris Bonsou Nguemo
- Microbiology and Pharmacology Laboratory, Department of Biochemistry, Faculty of Science, University of Dschang, P. O. Box 67 Dschang, Cameroon
| | - Hubert Leundji
- Gastroenterology Department, Laquintinie Hospital of Douala, P. O. Box 4035 Douala, Cameroon
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Alizadeh-Naini M, Yousefnejad H, Hejazi N. The beneficial health effects of Nigella sativa on Helicobacter pylori eradication, dyspepsia symptoms, and quality of life in infected patients: A pilot study. Phytother Res 2020; 34:1367-1376. [PMID: 31916648 DOI: 10.1002/ptr.6610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 11/27/2019] [Accepted: 12/23/2019] [Indexed: 01/02/2023]
Abstract
The aim of this study was to evaluate the effects of Nigella sativa (N. sativa) in addition to quadruple-therapy on Helicobacter pylori eradication, dyspepsia, biochemical-markers, and quality of life in infected patients. In this double-blind placebo-controlled clinical-trial, 51 H. pylori infected patients with functional dyspepsia were randomly assigned to treatment (quadruple-therapy with 2 g/day N. sativa) or placebo groups (quadruple-therapy with 2 g/day placebo) for 8 weeks. Serum levels of interleukin-8 (IL-8), high-sensitivity C-reactive protein (hs-CRP) and malondialdehyde, quality of life, dyspepsia, food-intake, body-weight, and body mass index (BMI) were evaluated at the baseline and at the end of the study. H. pylori eradication was evaluated at the end of the intervention. At the end of the study, H. pylori eradication was more in the N. sativa group compared with the placebo (p = .01). Weight, BMI, and dietary-intake (p < .05) increased significantly as compared with placebo. A significant improvement was also observed in patients' quality of life in the treatment group compared with the placebo (p < .05). The differences of biochemical-markers and dyspepsia between the two groups were not significant. So, N. sativa supplementation with medical treatment may have beneficial effects on H. pylori eradication, weight, BMI, dietary-intake, and quality of life in infected patients.
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Affiliation(s)
- Mahvash Alizadeh-Naini
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hedieh Yousefnejad
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Hejazi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Gebeyehu E, Nigatu D, Engidawork E. Self-reported adverse drug effects and associated factors among H. pylori infected patients on standard triple therapy: Prospective follow up study. PLoS One 2019; 14:e0225585. [PMID: 31756217 PMCID: PMC6874330 DOI: 10.1371/journal.pone.0225585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background One of the most common reasons for poor medication adherence and associated treatment failure of triple therapy is adverse drug effect (ADEs) of medications. Objective Assessment of ADEs and associated factors during H. pylori eradication therapy. Method Consented H. pylori positive adult outpatients on standard triple therapy (proton pump inhibitor, amoxicillin and clarithromycin) were involved in this facility based follow up study from May 2016 to April 2018 at Bahir Dar city in Ethiopia. Pre-developed questionnaire and formats were used to collect sociodemographic, medical information, and patient practice data before, during, and after therapy. Bivariate and backward stepwise multivariate logistic regression was used to analyze data. P-value < 0.05 at 95%CI was considered as significant. Result A total of 421 patients were involved in the study. Almost 80% of the patients were urban residents. Mean (±SD) age and body weight of patients were 30.63 (± 10.74) years and 56.79 (± 10.17) kg, respectively. ADE was reported from 26.1% of the patients and of all the reported ADEs, more than 85% was manifested with gastrointestinal symptoms which include gastrointestinal discomfort(39.1%), nausea (13.6%), constipation(12.7%), diarrhea(12.9%) and anorexia(10%). Determinants of self-reported ADEs among patients in the present study were body mass index above 25 (AOR: 2.55; 95%CI (1.21–5.38), p = 0.014), duration of acid-pepsin disorder more than 3weeks (AOR: 3.57; 95%CI (1.63–7.81), p = 0.001), pain feeling during long interval between meals (AOR: 2.14; 95%CI (1.19–3.84), p = 0.011), and residence in urban area (AOR: 1.95; 95% CI (1.04–3.67), p = 0.038). Conclusion Significant proportion of patients reported ADEs which commonly manifested with gastrointestinal symptoms. Consideration of patients’ body mass index, duration of the disorder, period of the day when patients feel pain, and patients’ area of residence could help to reduce ADEs experienced during H. pylori eradication therapy.
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Affiliation(s)
- Endalew Gebeyehu
- Department of Pharmacology, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegn Nigatu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Parsi A, Biuseh M, Mohammadi S, Hajiani E, Hashemi SJ, Saeidian H, Biuseh M. Study of probiotic and simvastatin additive effect on Helicobacter pylori eradication rate. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190003a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Abazar Parsi
- Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Biuseh
- Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Mohammadi
- Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Eskandar Hajiani
- Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Jalal Hashemi
- Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hooman Saeidian
- Department of Pharmaceutics, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Biuseh
- Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhou BG, Chen LX, Li B, Wan LY, Ai YW. Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis. Helicobacter 2019; 24:e12651. [PMID: 31414551 DOI: 10.1111/hel.12651] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Whether Saccharomyces boulardii (S boulardii) as an adjuvant therapy are beneficial to H pylori eradication remains controversial. The aim of the study was to update and determine the effects of S boulardii as an adjuvant therapy on H pylori eradication rates and adverse effects. METHODS We searched PubMed, Embase, CENTRAL, and Web of Science to collect all randomized controlled trials assessing the effects of S boulardii as an adjuvant therapy for H pylori eradication from inception to February 2019. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis was performed to control the risk of type I and type II errors. RESULTS Eighteen trials with 3592 patients were eligible for meta-analysis. Compared with standard eradication regimen, the S boulardii supplementation could significantly improve eradication rates [risk ratio (RR) = 1.09, 95% confidence interval (CI):1.05-1.13; moderate quality evidence] and reduce the incidence of total side effects (RR = 0.47, 95%CI:0.36-0.61; low quality evidence), as well as some gastrointestinal adverse effects, especially diarrhea (RR = 0.33, 95%CI:0.23-0.47; low quality evidence) and constipation (RR = 0.37, 95%CI:0.23-0.57; moderate quality evidence). In addition, the need for discontinuation rate in S boulardii supplementation group was significantly lower than in the control group (RR = 0.33, 95%CI:0.16-0.69, P = .003; moderate quality evidence). The TSA results for overall eradication rates and total side effects indicated that the effects were conclusive. CONCLUSIONS Our meta-analysis shows that S boulardii supplementation on standard eradication therapy significantly increased H pylori eradication rates and reduced the incidence of total side effects and some gastrointestinal adverse effects during eradication therapy.
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Affiliation(s)
- Ben-Gang Zhou
- Department of Gastroenterology, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, China
| | - Ling-Xiao Chen
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, China
| | - Lin-Yan Wan
- Department of Gastroenterology, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, China
| | - Yao-Wei Ai
- Department of Gastroenterology, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, China
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Yoon JY, Cha JM, Hong SS, Kim HK, Kwak MS, Jeon JW, Shin HP. Fermented milk containing Lactobacillus paracasei and Glycyrrhiza glabra has a beneficial effect in patients with Helicobacter pylori infection: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore) 2019; 98:e16601. [PMID: 31464895 PMCID: PMC6736393 DOI: 10.1097/md.0000000000016601] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lactobacillus paracasei and Glycyrrhiza glabra have been reported as having beneficial effects on Helicobacter pylori infection. We aimed to assess the efficacy and safety of fermented milk containing L paracasei HP7 and G glabra in patients with H pylori infection. METHODS This multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial was conducted in 2 hospitals from April to December 2017. Patients with H pylori infection were randomized into either the treatment group (fermented milk with L paracasei HP7 and G glabra) or placebo group (fermented milk only) once daily for 8 weeks. The primary endpoint was the gastric load of H pylori measured by C-urea breath test (UBT). Secondary endpoints were histologic and clinical improvement. RESULTS A total of 142 patients were randomly allocated to the treatment (n = 71) or placebo groups (n = 71). Compared to baseline data, the quantitative value of C-UBT at 8 weeks was significantly reduced in the treatment group (from 20.8 ± 13.2% to 16.9 ± 10.8%, P = .035), but not in the placebo group (P = .130). Chronic inflammation improved significantly only in the treatment group (P = .013), whereas the neutrophil activity deteriorated significantly only in the placebo group (P = .003). Moreover, the treatment group had significant improvement in gastrointestinal symptoms (P = .049) and quality of life (P = .029). No serious adverse events were observed. CONCLUSION The combination of fermented milk containing L paracasei and G glabra reduced H pylori density and improved histologic inflammation. However, their mechanisms of action should be elucidated in further studies.
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Affiliation(s)
- Jin Young Yoon
- Department of Internal Medicine, Division of Gastroenterology, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine
| | - Jae Myung Cha
- Department of Internal Medicine, Division of Gastroenterology, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine
| | | | - Hyung Kyung Kim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Division of Gastroenterology, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine
| | - Jung Won Jeon
- Department of Internal Medicine, Division of Gastroenterology, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine
| | - Hyun Phil Shin
- Department of Internal Medicine, Division of Gastroenterology, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine
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Abstract
Probiotics have been explored in an exponentially increasing number of clinical trials for their health effects. Drawing conclusions from the published literature for the medical practitioner is difficult since rarely more than two clinical trials were conducted with the same probiotic strain against the same medical condition. Consequently, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) made a few recommendations restricting it to probiotic use against acute gastroenteritis and antibiotic-associated diarrhea. Recent studies also made a strong case for probiotic use against sepsis in preterm and term infants from developing countries. Conclusions on the value of probiotics are best based on detailed meta-analyses (MA) of randomized controlled trials (RCT). Outcomes of MA are discussed in the present review for a number of gastroenterology conditions. Since these MA pool data from trials using different probiotic species, large RCT published sometimes come to different conclusions than MA including these studies. This is not necessarily a contradiction but may only mean that the specific probiotic species did not work under the specified conditions. Positive or negative generalization about probiotics and prebiotics should be avoided. Credible effects are those confirmed in independent trials with a specified probiotic strain or chemically defined prebiotic in a specified patient population under the specified treatment conditions. Even distinct technological preparations of the same probiotic strain might affect clinical outcomes if they alter bacterial surface structures. Underpowered clinical trials are another problem in the probiotic field. Data obtained with sophisticated omics technologies, but derived from less than ten human subjects should be interpreted with caution even when published in high impact journals.
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Affiliation(s)
- Harald Brüssow
- Laboratory of Gene Technology, Department of Biosystems, KU Leuven University, Kasteelpark Arenberg 21, Leuven, 3001, Belgium
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Lee MY, Choi SC, Kim YS. The Role of Gut Microbiota and Use of Probiotics in the Treatment of Upper Gastrointestinal Diseases. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.19.2.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Suez J, Zmora N, Segal E, Elinav E. The pros, cons, and many unknowns of probiotics. Nat Med 2019; 25:716-729. [DOI: 10.1038/s41591-019-0439-x] [Citation(s) in RCA: 630] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
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Effect of probiotic and synbiotic supplementation on inflammatory markers in health and disease status: A systematic review and meta-analysis of clinical trials. Clin Nutr 2019; 39:789-819. [PMID: 31060892 DOI: 10.1016/j.clnu.2019.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
The current systematic review and meta-analysis investigated the effect of probiotic/synbiotic on a wide range of inflammatory and anti-inflammatory markers in healthy and various disease conditions. PubMed, SCOPUS and Web of Science databases were searched. All clinical trials which investigated the effect of oral administration of probiotic or synbiotic on inflammatory markers (C-reactive protein (CRP), interleukin (IL) 1β, IL-4, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor (TNF) α, interferon (IFN) γ and transforming growth factor (TGF) β) for more than one week with concurrent control groups were included. One-hundred sixty seven publications was analysed. Results were as follows: CRP decreased in healthy, metabolic disorders, inflammatory bowel disease (IBD), arthritis and critically ill condition but not in renal failure. IL-1B: no change in healthy subjects and arthritis. TNF-α: decreased in healthy, fatty liver, IBD and hepatic cirrhosis, no change in diabetes, metabolic syndrome (MS) + PCOS (polycystic ovary syndrome) and arthritis. IL-6: no change in healthy, metabolic disorders and arthritis, increased in cirrhosis and renal failure, decreased in PCOS + MS. IL-10: no change in healthy, IBD and metabolic disorders, increased in arthritis. IL-4, IL-8, IL-12, IFN-g and TGF-b: no change in healthy subjects. In conclusion, probiotic/synbiotic decreased some of the inflammatory markers. The intervention was most effective in CRP and TNF-α reduction in healthy or disease state. Moreover, the intervention decreased inflammation most effectively in the following disease conditions, respectively: IBD, arthritis, fatty liver. PROSPERO REGISTRATION NUMBER: CRD42018088688.
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Abstract
Technological developments, including massively parallel DNA sequencing, gnotobiotics, metabolomics, RNA sequencing and culturomics, have markedly propelled the field of microbiome research in recent years. These methodologies can be harnessed to improve our in-depth mechanistic understanding of basic concepts related to consumption of probiotics, including their rules of engagement with the indigenous microbiome and impacts on the human host. We have recently demonstrated that even during probiotic supplementation, resident gut bacteria in a subset of individuals resist the mucosal presence of probiotic strains, limiting their modulatory effect on the microbiome and on the host gut transcriptional landscape. Resistance is partly alleviated by antibiotics treatment, which enables probiotics to interact with the host at the gut mucosal interface, although rather than promoting reconstitution of the indigenous microbiome and of the host transcriptional profile, they inhibit these components from returning to their naïve pre-antibiotic configurations. In this commentary, we discuss our findings in the context of previous and recent works, and suggest that incorporating the state-of-the-art methods currently utilized in microbiome research into the field of probiotics may lead to improved understanding of their mechanisms of activity, as well as their efficacy and long-term safety.
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Affiliation(s)
- Jotham Suez
- Immunology Department, Weizmann Institute of Science, Rehovot, Israel
| | - Niv Zmora
- Immunology Department, Weizmann Institute of Science, Rehovot, Israel,Digestive Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel,Internal Medicine Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Elinav
- Immunology Department, Weizmann Institute of Science, Rehovot, Israel,Cancer-Microbiome Research Division, DKFZ, Heidelberg, Germany,CONTACT Eran Elinav Immunology Department, Weizmann Institute of Science, 234 Herzl Street, Rehovot 7610001, Israel
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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 (Baltimore) 2019; 98:e15180. [PMID: 30985706 PMCID: PMC6485819 DOI: 10.1097/md.0000000000015180] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Due to decreasing eradication rate and increasing side effects, probiotics have gradually become an important supplement to standard eradication regimens for Helicobacter pylori. OBJECTIVE To evaluate the effectiveness and safety of probiotics in facilitating the eradication of H pylori and to explore the best timing and duration of probiotic supplementation, use of eradication regimens, strains, locations, and common side effects. METHODS Eligible studies were retrieved from the PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI databases, and we applied the Stata 12.0 software for the standard meta-analysis and network meta-analysis. RESULTS Forty eligible studies with 8924 patients were included in the analysis. We used a random-effects model (I = 52.1% and I = 81.4%) to analyze the eradication rate and the incidence of total side effects by intention to treat (ITT). Compared with the control group, a higher eradication rate (relative risk [RR] 1.140, 95% confidence interval (CI) 1.101-1.180, P < .001) and lower incidence of total side effects (RR 0.470, 95% CI 0.391-0.565, P < .001) were observed in the probiotic group. In the subgroup analysis, we evaluated the surface under the cumulative ranking curve scores for the before + same (75.2%), >2 weeks (92.6%), probiotic + quadruple regimen (99.9%), Lactobacillus (73.6%), multiple strains (72.1%), China (98.5%) groups. The rankings of common side effects are shown in Table 6. SUCRA scores for diarrhea (39.7%), abdominal pain (43.9%), nausea (78.8%), taste disturbance (99.6%), vomiting (7.1%), and constipation (30.9%) were reported. The consistency of all comparison groups was good. CONCLUSIONS Probiotics improved the eradication rate and reduced side effects when added to the treatments designed to eradicate H pylori. The use of probiotics before the eradication treatment and throughout the eradication treatment, and also the use of probiotics for more than 2 weeks, exerted better eradication effects. Probiotics combined with the bismuth quadruple regimen was the best combination. Lactobacillus and multiple strains were better choices of probiotic strains. The eradication effect observed in China was better than the effect observed in other countries.
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Affiliation(s)
- Xiaoguang Shi
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Junhong Zhang
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Lingshan Mo
- Department of Gastroenterology, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang
| | - Jialing Shi
- Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Mengbin Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Xue Huang
- Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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The effect of synbiotics in improving Helicobacter pylori eradication: A systematic review and meta-analysis. Complement Ther Med 2019; 43:36-43. [DOI: 10.1016/j.ctim.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open
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Role of Probiotics in Helicobacter pylori Eradication: Lessons from a Study of Lactobacillus reuteri Strains DSM 17938 and ATCC PTA 6475 (Gastrus®) and a Proton-Pump Inhibitor. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:3409820. [PMID: 31065301 PMCID: PMC6466906 DOI: 10.1155/2019/3409820] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/09/2019] [Accepted: 02/26/2019] [Indexed: 12/25/2022]
Abstract
Background Meta-analyses involving >4000 subjects with probiotics added to antimicrobial Helicobacter pylori eradication therapy have reported a mean increase in the eradication rate of 12 to 14%. It is unclear how to translate that result into clinical practice. Aim To evaluate whether administration of Lactobacillus reuteri plus a PPI without antibiotics would eradicate H. pylori infections. Methods This was a double-blind placebo-controlled randomized 2-site study of L. reuteri (Gastrus®) at a dose of 2 × 108 CFU, 7 times per day, or matching placebo plus 20 mg pantoprazole b.i.d. for 4 weeks. Cure was defined by negative 13C-UBT, 4 weeks after therapy. Sample size required ≥50% cure rates for using probiotics as a clinically useful monotherapy. Results Recruitment was halted after 56 subjects because of the low cure rate; there were 8 dropouts; 48 subjects completed therapy (71% women, average age 49 years). The cure rates per protocol were 3/24 (12.5%; 95% CI 2.6-32%) with L. reuteri vs. 1/24 (4.1%) with placebo. Side effects (most often diarrhea) occurred infrequently (in 5/28 vs. 3/28; active vs. placebo therapy) (P=0.53). Conclusion L. reuteri plus a PPI therapy was unable to provide a clinically important rate of H. pylori eradication. The cure rate albeit low (12.5%) was essentially identical to that achieved when probiotics were added to antibiotic therapy. The incremental improvement was additive and independent of antimicrobial resistance or antibiotics use. Probiotics can reliably increase the cure rate to ≥90% only in regimens achieving cure rates of ∼80%. This trial is registered with NCT03404440.
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Quigley EMM. Prebiotics and Probiotics in Digestive Health. Clin Gastroenterol Hepatol 2019; 17:333-344. [PMID: 30267869 DOI: 10.1016/j.cgh.2018.09.028] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
As the importance of the gut microbiota in health and disease is increasingly recognized interest in interventions that can modulate the microbiota and its interactions with its host has soared. Apart from diet, prebiotics and probiotics represent the most commonly used substances taken in an effort to sustain a healthy microbiome or restore balance when it is believed bacterial homeostasis has been disturbed in disease. While a considerable volume of basic science attests to the ability of various prebiotic molecules and probiotic strains to beneficially influence host immune responses, metabolic processes and neuro-endocrine pathways, the evidence base from human studies leaves much to be desired. This translational gap owes much to the manner in which this sector is regulated but also speaks to the challenges that confront the investigator who seeks to explore microbiota modulation in either healthy populations or those who suffer from common digestive ailments. For many products marketed as probiotics, some of the most fundamental issues relating to quality control, such as characterization, formulation, viability safety are scarcely addressed.
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Affiliation(s)
- Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.
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69
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Kamiya S, Yonezawa H, Osaki T. Role of Probiotics in Eradication Therapy for Helicobacter pylori Infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1149:243-255. [PMID: 31016634 DOI: 10.1007/5584_2019_369] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Probiotics are defined as, "Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host", and have various effects including inhibitory capabilities on pathogens, stimulation of organ functions and activation of immune responses in the human. Probiotics were reported to inhibit Helicobacter pylori not only in vitro, but also in vivo studies. The mechanisms by which probiotics inhibit H. pylori infection include competition for nutrients, production of bactericidal substances, competitive inhibition of adherence and stimulation of host functions and immunity. In addition, probiotics are clinically used for eradication therapy of H. pylori infection, and the effects of probiotics as single treatment and combination use with other drugs including proton pump inhibitors and antibiotics against H. pylori are reported. It has been testified that probiotics increase the eradication rate and prevent adverse events including diarrhea, nausea, vomiting and taste disorder. In the Maastrich V/Florence Consensus Report 2017, it was stated that some probiotics may have a beneficial effect on H. pylori eradication and are effective in reducing side effects of eradication therapy, but more research is needed to answer several questions concerning the mechanisms of probiotics action. In addition, strain specificity, dosages and duration times of probiotics used for H. pylori eradication therapy need to be clarified in future studies.
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Affiliation(s)
- Shigeru Kamiya
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan. .,Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan.
| | - Hideo Yonezawa
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Takako Osaki
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
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70
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Fang HR, Zhang GQ, Cheng JY, Li ZY. Efficacy of Lactobacillus-supplemented triple therapy for Helicobacter pylori infection in children: a meta-analysis of randomized controlled trials. Eur J Pediatr 2019; 178:7-16. [PMID: 30446816 DOI: 10.1007/s00431-018-3282-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/30/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
Abstract
Therapy-related side effects and severe antimicrobial resistance still remain an obstacle to Helicobacter pylori eradication. This meta-analysis aimed to investigate the efficacy of Lactobacillus-supplemented triple therapy on H. pylori eradication rates and therapy-related side effects in children. Five studies involving 484 pediatric patients were included in our analysis. The pooled relative risk (RR) for eradication rates in the Lactobacillus group versus the control group was 1.19 [95% confidence interval (CI) 1.07-1.33]. In subgroup analyses based on dose and duration of Lactobacillus supplementation, the pooled RRs for eradication rates were 1.36 (95% CI 1.15-1.60) in the high-dose group, 1.08 (95% CI 0.86-1.35) in the low-dose group, 1.24 (95% CI 1.06-1.46) in the long-term group, and 1.17 (95% CI 0.96-1.44) in the short-term group. With respect to side effects, Lactobacillus supplementation significantly reduced the incidence of diarrhea (RR = 0.30, 95% CI 0.10-0.85).Conclusions: Lactobacillus, as an adjunct to triple therapy, can increase H. pylori eradication rates as well as reduce the incidence of therapy-related diarrhea in children. And a higher dose and a longer duration of supplementation may conduce to the positive impact of Lactobacillus on H. pylori eradication. What is Known: • Probiotics-supplemented triple therapy may be beneficial in improving H. pylori eradication rates and reducing therapy-related side effects in children. However, not all probiotics are beneficial to H. pylori eradication and the pooled outcomes based on different probiotics may be erroneously extrapolated to other ineffective strains. What is New: • Lactobacillus, as an adjunct to triple therapy, can increase H. pylori eradication rates as well as reduce the incidence of therapy-related diarrhea in children.
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Affiliation(s)
- Hao-Ran Fang
- Department of Gastroenterology, Ministry of Eduaction Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
| | - Guo-Qiang Zhang
- Department of Gastroenterology, Ministry of Eduaction Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
| | - Jing-Yi Cheng
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhong-Yue Li
- Department of Gastroenterology, Ministry of Eduaction Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
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71
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Gotoda T, Takano C, Kusano C, Suzuki S, Ikehara H, Hayakawa S, Andoh A. Gut microbiome can be restored without adverse events after Helicobacter pylori eradication therapy in teenagers. Helicobacter 2018; 23:e12541. [PMID: 30311721 DOI: 10.1111/hel.12541] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/25/2018] [Accepted: 09/02/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The effect of Helicobacter pylori eradication on the gut microbiota of teenagers is unknown; hence, this study aimed to assess changes in the gut microbiome after H. pylori eradication therapy in teenagers. MATERIALS AND METHODS Changes in gut microbiota before and after H. pylori eradication were prospectively investigated in eight students without any underlying diseases, via next-generation sequencing of 16S rDNA. Twenty-four stool samples were collected, and operational taxonomic unit analysis was performed. As secondary analyses, alpha and beta diversity were evaluated. Furthermore, pre-treatment microbiome compositions were compared with those 1 week and 2 months after treatment. RESULTS Alpha diversity analysis revealed that both species richness and evenness were recovered to pre-treatment levels at 2 months after eradication therapy. Slight but non-significant differences were observed in bacterial species abundance between pre- and post-treatment samples, upon beta diversity analysis. Although the relative abundance of Bacteroidetes tended to increase and that of Actinobacteria significantly decreased immediately after eradication therapy, the taxonomic composition was similar to that before treatment and at 2 months post-eradication. However, two students showed significant changes in the gut microbiota in relative abundances at the level of the phylum, class, and order. CONCLUSIONS Although H. pylori eradication therapy caused short-term dysbiosis, microbial diversity was restored in healthy teenagers. However, as the relative abundance of gut microbiota in some cases remained altered, the effect of H. pylori eradication therapy on the gut microbiome should be continuously monitored.
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Affiliation(s)
- Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Chika Takano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.,Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.,Division of Gastroenterology, Yuri Kumiai general hospital, Akita, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hisatomo Ikehara
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.,Division of Gastroenterology, Yuri Kumiai general hospital, Akita, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Akira Andoh
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
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Liu Y, Tran DQ, Rhoads JM. Probiotics in Disease Prevention and Treatment. J Clin Pharmacol 2018; 58 Suppl 10:S164-S179. [PMID: 30248200 PMCID: PMC6656559 DOI: 10.1002/jcph.1121] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/17/2018] [Indexed: 12/17/2022]
Abstract
Few treatments for human diseases have received as much investigation in the past 20 years as probiotics. In 2017, English-language meta-analyses totaling 52 studies determined the effect of probiotics on conditions ranging from necrotizing enterocolitis and colic in infants to constipation, irritable bowel syndrome, and hepatic encephalopathy in adults. The strongest evidence in favor of probiotics lies in the prevention or treatment of 5 disorders: necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and infant colic. Probiotic mechanisms of action include the inhibition of bacterial adhesion; enhanced mucosal barrier function; modulation of the innate and adaptive immune systems (including induction of tolerogenic dendritic cells and regulatory T cells); secretion of bioactive metabolites; and regulation of the enteric and central nervous systems. Future research is needed to identify the optimal probiotic and dose for specific diseases, to address whether the addition of prebiotics (to form synbiotics) would enhance activity, and to determine if defined microbial communities would provide benefit exceeding that of single-species probiotics.
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Affiliation(s)
- Yuying Liu
- Department of Pediatrics, Division of Gastroenterology, and the Pediatric Research Center, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Dat Q Tran
- Department of Pediatrics, Division of Gastroenterology, and the Pediatric Research Center, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - J Marc Rhoads
- Department of Pediatrics, Division of Gastroenterology, and the Pediatric Research Center, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
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73
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Lopetuso LR, Napoli M, Rizzatti G, Scaldaferri F, Franceschi F, Gasbarrini A. Considering gut microbiota disturbance in the management of Helicobacter pylori infection. Expert Rev Gastroenterol Hepatol 2018; 12:899-906. [PMID: 30040500 DOI: 10.1080/17474124.2018.1503946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Helicobacter pylori (Hp) infection produces drastic changes in the gastric microenvironment, which, in turn, influence the gastric microbiota composition and might be correlated with large intestinal microbiota changes. This excellent perturbing actor could trigger important modifications in the homeostatic functions exerted by gut commensals leading to a new gastrointestinal balance. At the same time, the therapeutic strategies used to eradicate Hp can modulate this physiological symbiosis, but can be also conversely affected by its properties. Area covered: The purpose of this review is to explore the reciprocal interplay between Hp infection and gut microbiota and analyze how microbial changes can influence the management of Hp eradication therapies. Expert commentary: While many studies have described Hp-dependent gut microbiota alterations, their clinical implications are only partially clear, as well as the mechanism of actions that sustain these processes. This represents a clear challenge for future research projects that will also need to understand which role is exerted by viruses, parasites, and yeasts.
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Affiliation(s)
- Loris R Lopetuso
- a Internal Medicine, Gastroenterology and Hepatology Department , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy
| | - Marco Napoli
- a Internal Medicine, Gastroenterology and Hepatology Department , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy
| | - Gianenrico Rizzatti
- a Internal Medicine, Gastroenterology and Hepatology Department , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy
| | - Franco Scaldaferri
- a Internal Medicine, Gastroenterology and Hepatology Department , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy
| | - Francesco Franceschi
- a Internal Medicine, Gastroenterology and Hepatology Department , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy
| | - Antonio Gasbarrini
- a Internal Medicine, Gastroenterology and Hepatology Department , Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore , Roma , Italy
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The impact of Helicobacter pylori infection, eradication therapy and probiotic supplementation on gut microenvironment homeostasis: An open-label, randomized clinical trial. EBioMedicine 2018; 35:87-96. [PMID: 30145102 PMCID: PMC6161473 DOI: 10.1016/j.ebiom.2018.08.028] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/11/2018] [Accepted: 08/11/2018] [Indexed: 02/06/2023] Open
Abstract
Background Helicobacter pylori (H. pylori) infection is associated with remodeling of gastric microbiota. However, comprehensive analyses of the impact of H. pylori infection, eradication therapy and probiotic supplementation on gut microbiota are still lacking. We aimed to provide evidence for clinical decision making. Methods Seventy H. pylori-positive and 35 H. pylori-negative patients (group C) were enrolled. H. pylori-positive patients were randomly assigned to group A (14-day bismuth-containing quadruple therapy) and group B (quadruple therapy supplemented with Clostridium butyricum). Stool samples of group A and B were collected on day 0, 14 and 56 while stool samples of group C were collected on day 0. Gut microbiota was investigated by 16S rRNA sequencing. Findings The Sobs index (richness estimator) was significantly higher in H. pylori-positive samples than H. pylori-negative samples (p < .05). Several metabolic pathways were more abundant in H. pylori-positive communities while some disease-associated pathways had higher potential in H. pylori-negative community through KEGG pathway analysis. Abundances of most butyrate-producing bacteria significantly decreased, while several detrimental bacteria increased after eradication therapy. Probiotic supplementation was associated with improved gastrointestinal symptoms as well as increased Bacteroidetes:Firmicutes ratio. Interpretation While H. pylori infection may not be necessarily detrimental in all patients, eradication of H. pylori was associated with widespread changes in gut microbial ecology and structure. Probiotic supplementation could relieve more gastrointestinal symptoms by inducing alterations in gut microbiota and host immune responses. As such, the decision to eradicate H. pylori should be based on comprehensive analysis of individual patients.
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75
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Koretz RL. Probiotics in Gastroenterology: How Pro Is the Evidence in Adults? Am J Gastroenterol 2018; 113:1125-1136. [PMID: 29915396 DOI: 10.1038/s41395-018-0138-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 04/20/2018] [Indexed: 12/11/2022]
Abstract
Probiotic usage has become popular with both medical practitioners and the community in general; patients commonly seek advice regarding what, if any, such preparation would be useful for their own diseases. Since such advice should be evidence-based, identified randomized clinical trials (RCTs) for a number of gastrointestinal conditions were reviewed; the data were organized by individual probiotic genera/species. Only trials in adults were considered. Most of the identified RCTs were small and low-quality, so any conclusions to be drawn will be limited at least by methodologic problems. Using the GRADE system to consider the reliability of the evidence generated from these RCTs, it did appear that the use of fecal microbial transplantation to treat recurrent Clostridium difficile infection is well justified. Given the methodologic issues, there was moderately good evidence for preventing antibiotic-associated diarrhea with Lactobacillus, Bifidobacterium, Streptococcus, or Saccharomyces boulardii and for using Lactobacillus, Bifidobacterium, or Saccharomyces as adjunct therapy in the treatment of Helicobacter pylori. There were other conditions for which some supportive evidence was available. These conditions include VSL#3 for maintaining remissions in patients with pouchitis or treating active ulcerative colitis (UC), fecal microbial transplantation for treating active UC, Bifidobacterium for treating patients with UC in remission, Lactobacillus in patients with painful diverticulosis, a variety of probiotics (Lactobacillus, Bifidobacterium, Streptococcus, or VSL#3) in patients with minimal hepatic encephalopathy, and providing synbiotics to patients postoperatively after liver transplantation. Unfortunately, other limitations in the evidence made it very likely that future research will have an effect on the estimated benefit; these interventions cannot yet be recommended for routine use.
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Affiliation(s)
- Ronald L Koretz
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA. Emeritus Professor of Clinical Medicine, David Geffen-UCLA School of Medicine, Los Angeles, CA, USA.,Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA. Emeritus Professor of Clinical Medicine, David Geffen-UCLA School of Medicine, Los Angeles, CA, USA
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76
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Cisarò F, Pizzol A, Pinon M, Calvo PL. Diagnosis and treatment of Helicobacter pylori in the pediatric population. Minerva Pediatr 2018; 70:476-487. [PMID: 30021412 DOI: 10.23736/s0026-4946.18.05346-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although about 35 years have elapsed since the discovery of the Helicobacter pylori, its diagnosis and the choice of optimal eradication therapy are still to be defined. Over time, there has been an increase in interest, publications, recommendations and guidelines. Moreover, management of the disease in pediatric subjects differs somewhat to that of adults and requires a more delicate approach leading to alternative strategies for both diagnosis and treatment. Which patient should be investigated for H. pylori, when to perform noninvasive or invasive tests, what are the proper therapeutic options and best antibiotics regimen to eradicate the infection are practices changing with evidences through time. Therefore, an updated guideline was published by the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) in 2017. The aim of this review is to highlight what is new and what differs between adult and pediatric population regarding the management of H. pylori infection after the ESPGHAN/NASPGHAN guidelines, enriched with updates from literature reviews published over the last two years.
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Affiliation(s)
- Fabio Cisarò
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Pizzol
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy -
| | - Michele Pinon
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Pier Luigi Calvo
- Unit of Pediatric Gastroenterology, Department of Pediatrics, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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77
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Park JS, Park JE, Oh BS, Yoon BW, Kim HK, Lee JW, Kim NH, Cho WS, Woo YS, Jahng J, Kim YS. [Trend in the Eradication Rates of Helicobacter pylori Infection Over the Last 10 Years in West Gyeonggi-do, Korea: A Single Center Experience]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 70:232-238. [PMID: 29161792 DOI: 10.4166/kjg.2017.70.5.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background/Aims The eradication rate of Helicobacter pylori (H. pylori) has been decreasing recently in Korea due to antibiotics resistance. The aim of this study was to investigate the trend of eradication rate and clinical factors affecting the eradication rate of H. pylori in the last 10 years in west Gyeonggi-do, Korea. Methods The trends of eradication rate of H. pylori, gender, age, concomitant mediations, and clinical factors were retrospectively evaluated in patients with H. pylori infection between 2006 and 2015 (n=2,485). Results The overall H. pylori eradication rate for the standard triple therapy was 82.5%. The annual eradication rates from 2006 to 2015 were 90%, 77.9%, 75.8%, 83.2%, 85.6%, 90.1%, 81.3%, 81.1%, 78.7%, and 78.8%, respectively, showing a significant decrement during the last five years (p<0.001). Higher eradication rate was observed in males than in females (p<0.001). Esomeprazole showed a higher eradication rate compared with pantoprazole between 2006 and 2010 (p<0.022). Age and the use of probiotics and mucosal protective agents played no significant role in the H. pylori eradication rate. The overall eradication rate for bismuth-based quadruple therapy was 94.4%. Conclusions The eradication rate of H. pylori over the last 10 years for first-line therapy ranged from 75.8 to 90.1%; the eradication rate for triple therapy has declined. However, the eradication rate for quadruple therapy has remained unchanged over the last 10 years.
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Affiliation(s)
- Jong Seol Park
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Ji Eun Park
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Byoung Soo Oh
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Byung Wook Yoon
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Hyun Ki Kim
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Jae Won Lee
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Nam Ho Kim
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Won Seok Cho
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Young Sik Woo
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jaehoon Jahng
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Yong Sung Kim
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Korea
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McFarland LV, Evans CT, Goldstein EJC. Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2018; 5:124. [PMID: 29868585 PMCID: PMC5949321 DOI: 10.3389/fmed.2018.00124] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/13/2018] [Indexed: 01/01/2023] Open
Abstract
Background As the use and diversity of probiotic products expands, the choice of an appropriate type of probiotic is challenging for both medical care professionals and the public alike. Two vital factors in choosing the appropriate probiotic are often ignored, namely, the probiotic strain-specificity and disease-specificity for efficacy. Reviews and meta-analyses often pool together different types of probiotics, resulting in misleading conclusions of efficacy. Methods A systematic review of the literature (1970-2017) assessing strain-specific and disease-specific probiotic efficacy was conducted. Trials were included for probiotics with an identifiable strain (either single strain or mixtures of strains) that had at least two randomized, controlled trials for each type of disease indication. The goal was to determine if probiotic strains have strain and/or disease-specific efficacy. Results We included 228 trials and found evidence for both strain specificity and disease specificity for the efficacy of specific probiotic strains. Significant efficacy evidence was found for 7 (70%) of probiotic strain(s) among four preventive indications and 11 (65%) probiotic strain(s) among five treatment indications. Strain-specific efficacy for preventing adult antibiotic-associated diarrhea was clearly demonstrated within the Lactobacillus species [e.g., by the mixture of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, and Lactobacillus rhamnosus CLR2 (Bio-K+®), by L. casei DN114001 (Actimel®) and by Lactobacillus reuteri 55730], while other Lactobacillus strains did not show efficacy. Significant disease-specific variations in efficacy was demonstrated by L. rhamnosus GG and Saccharomyces boulardii CNCM I-745, as well as other probiotic strains. Conclusion Strong evidence was found supporting the hypothesis that the efficacy of probiotics is both strain-specific and disease-specific. Clinical guidelines and meta-analyses need to recognize the importance of reporting outcomes by both specific strain(s) of probiotics and the type of disease. The clinical relevance of these findings indicates that health-care providers need to take these two factors into consideration when recommending the appropriate probiotic for their patient.
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Affiliation(s)
- Lynne V McFarland
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington Medical Center, Seattle, WA, United States
| | - Charlesnika T Evans
- Department of Preventive Medicine and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Veterans Affairs (VA), Center of Innovation of Complex Chronic Healthcare (CINCCH), Edward Hines Jr VA Hospital, Hines, IL, United States
| | - Ellie J C Goldstein
- RM Alden Research Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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79
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Siddique O, Ovalle A, Siddique AS, Moss SF. Helicobacter pylori Infection: An Update for the Internist in the Age of Increasing Global Antibiotic Resistance. Am J Med 2018; 131:473-479. [PMID: 29353050 DOI: 10.1016/j.amjmed.2017.12.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori infects approximately half the world's population and is especially prevalent in the developing world. H. pylori is an important cause of global ill health due to its known etiological role in peptic ulcer disease, dyspepsia, gastric cancer, lymphoma, and more recently, recognized in iron deficiency anemia and idiopathic thrombocytopenic purpura. Increased antibiotic usage worldwide has led to antibiotic resistance among many bacteria, including H. pylori, resulting in falling success rates of first-line anti-H. pylori therapies. Eradication failures are principally due to resistance to clarithromycin, levofloxacin, and metronidazole. Several new treatment options or modifications of established regimens are now recommended by updated practice guidelines for primary or secondary therapy. Because these updated recommendations were published in the gastroenterological literature, internists and primary care physicians, who commonly manage H. pylori, may be unaware of these advances. In this review, we outline the changing epidemiology of H. pylori, advise on diagnostic test selection for patients not undergoing endoscopy, and highlight current management options in this era of growing antibacterial resistance.
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Affiliation(s)
- Osama Siddique
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Anais Ovalle
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | | | - Steven F Moss
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI; Division of Gastroenterology and Hepatology, Alpert Medical School of Brown University, Providence, RI.
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80
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Hungin APS, Mitchell CR, Whorwell P, Mulligan C, Cole O, Agréus L, Fracasso P, Lionis C, Mendive J, Philippart de Foy J, Seifert B, Wensaas K, Winchester C, de Wit N. Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus. Aliment Pharmacol Ther 2018; 47:1054-1070. [PMID: 29460487 PMCID: PMC5900870 DOI: 10.1111/apt.14539] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/15/2017] [Accepted: 01/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems. AIM To update the consensus with new evidence. METHODS A systematic review identified randomised, placebo-controlled trials published between January 2012 and June 2017. Evidence was graded, previously developed statements were reassessed by an 8-expert panel, and agreement was reached via Delphi consensus. RESULTS A total of 70 studies were included (IBS, 34; diarrhoea associated with antibiotics, 13; diarrhoea associated with Helicobacter pylori eradication therapy, 7; other conditions, 16). Of 15 studies that examined global IBS symptoms as a primary endpoint, 8 reported significant benefits of probiotics vs placebo. Consensus statements with 100% agreement and "high" evidence level indicated that specific probiotics help reduce overall symptom burden and abdominal pain in some patients with IBS and duration/intensity of diarrhoea in patients prescribed antibiotics or H. pylori eradication therapy, and have favourable safety. Statements with 70%-100% agreement and "moderate" evidence indicated that, in some patients with IBS, specific probiotics help reduce bloating/distension and improve bowel movement frequency/consistency. CONCLUSIONS This updated review indicates that specific probiotics are beneficial in certain lower GI problems, although many of the new publications did not report benefits of probiotics, possibly due to inclusion of new, less efficacious preparations. Specific probiotics can relieve lower GI symptoms in IBS, prevent diarrhoea associated with antibiotics and H. pylori eradication therapy, and show favourable safety. This study will help clinicians recommend/prescribe probiotics for specific symptoms.
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81
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Opekun AR, Gonzales SA, Al-Saadi MA, Graham DY. Brief report: Lactobacillus bulgaricus GLB44 (Proviotic ™ ) plus esomeprazole for Helicobacter pylori eradication: A pilot study. Helicobacter 2018; 23:e12476. [PMID: 29504209 PMCID: PMC6913170 DOI: 10.1111/hel.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies of Lactobacillus delbrueckii subsp. bulgaricus GLB44 plus a proton-pump inhibitor (PPI) reported cures of more than 90% of patients with active Helicobacter pylori infections. AIM To confirm the high H. pylori cure rates reported previously. METHOD A pilot study was done in healthy H. pylori-infected volunteers using 3-gram sachet (3 billion cells) of L. delbrueckii GLB44 plus 22.3 mg of esomeprazole b.i.d., for 14 days. The result was determined by urea breath testing 4 weeks after therapy. Stopping rules required for ending enrollment if less than 3 of the first 10 subjects were cured. RESULTS Nine subjects were entered and because all failed to achieve negative urea breath test, the stopping rule required the study to end. CONCLUSION We were unable to confirm reports of achieving a high H. pylori cure rate with L. delbrueckii GLB44 plus a PPI.
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Affiliation(s)
- Antone R Opekun
- Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Savannah A Gonzales
- Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Mahmoud A Al-Saadi
- Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - David Y Graham
- Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
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82
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Pérez-Arellano E, Rodriguez-Garcia MI, Galera Rodenas AB, de la Morena-Madrigal E. Erradicación de la infección por Helicobacter pylori con una nueva terapia cuádruple basada en bismuto en la práctica clínica. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:145-152. [DOI: 10.1016/j.gastrohep.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
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83
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Losurdo G, Cubisino R, Barone M, Principi M, Leandro G, Ierardi E, Di Leo A. Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis. World J Gastroenterol 2018; 24:139-149. [PMID: 29358890 PMCID: PMC5757118 DOI: 10.3748/wjg.v24.i1.139] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To define probiotic monotherapy effect on Helicobacter pylori (H. pylori) status by performing a systematic review.
METHODS Methods of analysis and inclusion criteria were based on PRISMA recommendations. Relevant publications were identified by searching PubMed, MEDLINE, Science Direct, and EMBASE. The end-point was to estimate eradication rate and urea breath test delta value before and after probiotic monotherapy across all studies and, overall, with a pooled data analysis. Adverse events of probiotic therapy were evaluated. The data were expressed as proportions/percentages, and 95%CIs were calculated. For continuous variables, we evaluated the weighted mean difference. Odd ratios (ORs) were calculated according to the Peto method for the comparison of eradication rates between probiotics and placebo.
RESULTS Eleven studies were selected. Probiotics eradicated H. pylori in 50 out of 403 cases. The mean weighted eradication rate was 14% (95%CI: 2%-25%, P = 0.02). Lactobacilli eradicated the bacterium in 30 out of 235 patients, with a mean weighted rate of 16% (95%CI: 1%-31%). Saccharomyces boulardii achieved eradication in 6 out of 63 patients, with a pooled eradication rate of 12% (95%CI: 0%-29%). Multistrain combinations were effective in 14 out of 105 patients, with a pooled eradication rate of 14% (95%CI: 0%-43%). In the comparison of probiotics vs placebo, we found an OR of 7.91 in favor of probiotics (95%CI: 2.97-21.05, P < 0.001). Probiotics induced a mean reduction in delta values higher than placebo (8.61% with a 95%CI: 5.88-11.34, vs 0.19% for placebo, P < 0.001). Finally, no significant difference in adverse events was found between probiotics and placebo (OR = 1, 95%CI: 0.06-18.08).
CONCLUSION Probiotics alone show a minimal effect on H. pylori clearance, thus suggesting a likely direct role.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Rossella Cubisino
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Gioacchino Leandro
- National Institute of Gastroenterology, “S De Bellis” Research Hospital, Via Turi, Castellana Grotte (BA) 70013, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
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Goderska K, Agudo Pena S, Alarcon T. Helicobacter pylori treatment: antibiotics or probiotics. Appl Microbiol Biotechnol 2018; 102:1-7. [PMID: 29075827 PMCID: PMC5748437 DOI: 10.1007/s00253-017-8535-7] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/14/2017] [Accepted: 09/16/2017] [Indexed: 01/10/2023]
Abstract
Treatment of Helicobacter pylori infection is important for the management of gastrointestinal disorders such as peptic ulcer and gastric cancer. Due to the increase in the prevalence of H. pylori resistance to antibiotics, triple therapy with clarithromycin is no longer the best treatment for H. pylori, especially in some areas where the local resistance to this antibiotic is higher than 20%. Alternative treatments have been proposed for the eradication of H. pylori. Some of them including novel antibiotics or classical ones in different combinations; these treatments are being used in the regular clinical practice as novel and more effective treatments. Others therapies are using probiotics associated to antibiotics to treat this infection.The present article is a revision of H. pylori eradication treatment, focusing on emerging approaches to avoid the treatment failure, using new therapies with antimicrobials or with probiotics.
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Affiliation(s)
- Kamila Goderska
- Faculty of Food Science and Nutrition, Institute of Food Technology of Plant Origin, Department of Fermentation and Biosynthesis, Poznan University of Life Sciences, Wojska Polskiego 31, 60-624, Poznan, Poland.
| | - Sonia Agudo Pena
- Faculty of Food Science and Nutrition, Institute of Food Technology of Plant Origin, Department of Fermentation and Biosynthesis, Poznan University of Life Sciences, Wojska Polskiego 31, 60-624, Poznan, Poland
| | - Teresa Alarcon
- Department of Microbiology, Hospital Universitario de La Princesa, 28006, Madrid, Spain
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85
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Cameron D, Hock QS, Kadim M, Mohan N, Ryoo E, Sandhu B, Yamashiro Y, Jie C, Hoekstra H, Guarino A. Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region. World J Gastroenterol 2017; 23:7952-7964. [PMID: 29259371 PMCID: PMC5725290 DOI: 10.3748/wjg.v23.i45.7952] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 02/06/2023] Open
Abstract
Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.
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Affiliation(s)
- Donald Cameron
- Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Melbourne 3052, Australia
| | - Quak Seng Hock
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Musal Kadim
- Child Health Department, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta 12220, Indonesia
| | - Neelam Mohan
- Department of Pediatric Gastroenterology, Hepatology And Liver Transplantation, Medanta The Medicity 122001, Gurugram Haryana, India
| | - Eell Ryoo
- Department of Pediatrics, Gachon University, Gil Gachon Children’s Hosptial, Incheon 21565, South Korea
| | - Bhupinder Sandhu
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Bristol BS2 8BJ, United Kingdom
| | - Yuichiro Yamashiro
- Probiotics Research Laboratory, Juntendo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Chen Jie
- The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 610041, Zhejiang Province, China
| | - Hans Hoekstra
- Department of Pediatrics, Hieronymus Bosch Hospital, ’s-Hertogenbosch 5223GZ, The Netherlands
| | - Alfredo Guarino
- Unit of Pediatrics Infectious Diseases and Clinical Nutrition of the Department of Translational Medical Science-Section of Pediatrics, University of Naples Federico II, Naples 80131, Italy
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86
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Wen J, Peng P, Chen P, Zeng L, Pan Q, Wei W, He J. Probiotics in 14-day triple therapy for Asian pediatric patients with Helicobacter pylori infection: a network meta-analysis. Oncotarget 2017; 8:96409-96418. [PMID: 29221216 PMCID: PMC5707110 DOI: 10.18632/oncotarget.21633] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/21/2017] [Indexed: 02/06/2023] Open
Abstract
Although 14-day triple therapy has been widely administrated for eradicating Helicobacter pylori (H. pylori) in Asia, its antibiotic-associated side effects restrict the effectivity of eradication therapy in pediatric patients. Therefore, a network meta-analysis (NMA) was conducted to compare the efficacy and safety of probiotics supplemented in 14-day triple therapy in Asian pediatric patients. Materials and Methods Randomized controlled trials (RCTs) were retrieved comprehensively in electronic databases (such as PubMed, Cochrane library, Embase, CNKI, Wan fang database, VIP database and CBM) until April 2017. Additional references were obtained from reviewed articles. NMA was performed using a random-effects model under a frequentist framework. Results Seventeen RCTs were included. NMA indicated that Bifidobacterium infantis+Clostridium butyricum was most beneficial for H. pylori eradication rates (P-score = 0.82) and Bacillus mesentericus+Clostridium butyricum+Streptococcus faecalis for total side effects (P-score = 0.77). Taken together, Bacillus mesentericus+Clostridium butyricum+Streptococcus faecalis was the best one to supplement in 14-day triple therapy due to its efficacy (P-score = 0.72) and safety (P-score = 0.77). Additionally, pairwise meta-analysis indicated that probiotics supplemented 14-day triple therapy significantly increased H. pylori eradication rates (RR: 1.16, 95%CI: 1.07–1.26) and reduced the incidence of total side effects (RR: 0.40, 95%CI: 0.34–0.48) compared with placebo. Conclusions Bacillus mesentericus+Clostridium butyricum+Streptococcus faecalis is the optimal probiotic regime of reducing total side effects and improving eradication rates when supplemented 14-day triple therapy. Further direct evidence is needed to warrant it.
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Affiliation(s)
- Juanjuan Wen
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Pailan Peng
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China.,Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Pengfei Chen
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China.,Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lirong Zeng
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Qinghua Pan
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Wenbin Wei
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Jianhua He
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
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Abstract
This review summarizes important studies regarding Helicobacter pylori therapy published from April 2016 to April 2017. The main themes that emerge involve studies assessing the efficacy of bismuth and nonbismuth quadruple regimens. While in recent years, much of the emphasis on the use of bismuth has focussed on its utility in a second-line setting, an increasing number of studies this year have shown excellent efficacy in first-line therapy. The efficacy of bismuth as a second-line after sequential and concomitant therapy was particularly noteworthy. Antibiotic resistance was more intensely studied this year than for a long time, and definite trends are presented regarding an increase in resistance, including the fact that clarithromycin resistance in particular is now at a level where the continued use of clarithromycin triple therapy first-line as a mainstream treatment is not recommended. Another exciting trend to emerge this year is the utility of vonoprazan as an alternative to PPI therapy, especially in resistant and difficult-to-treat groups.
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Affiliation(s)
- Anthony O'Connor
- Department of Gastroenterology, Tallaght Hospital/Trinity College Dublin, Dublin, Ireland
| | | | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Colm O'Morain
- Department of Gastroenterology, Tallaght Hospital/Trinity College Dublin, Dublin, Ireland
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Feng JR, Wang F, Qiu X, McFarland LV, Chen PF, Zhou R, Liu J, Zhao Q, Li J. Efficacy and safety of probiotic-supplemented triple therapy for eradication of Helicobacter pylori in children: a systematic review and network meta-analysis. Eur J Clin Pharmacol 2017; 73:1199-1208. [PMID: 28681177 DOI: 10.1007/s00228-017-2291-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/14/2017] [Indexed: 12/23/2022]
Abstract
AIM The aim of this study was to identify the best probiotic supplementation in triple therapy for pediatric population with Helicobacter pylori infection. METHODS Eligible trials were identified by comprehensive searches. Relative risks with 95% confidence intervals and relative ranks with P scores were assessed. RESULTS Twenty-nine trials (3122 participants) involving 17 probiotic regimens were identified. Compared with placebo, probiotic-supplemented triple therapy significantly increased H. pylori eradication rates (relative ratio (RR) 1.19, 95% CI 1.13-1.25) and reduced the incidence of total side effects (RR 0.49, 95% CI 0.38-0.65). Furthermore, to supplemented triple therapy, Lactobacillus casei was identified the best for H. pylori eradication rates (P score = 0.84), and multi-strain of Lactobacillus acidophilus and Lactobacillus rhamnosus for total side effects (P score = 0.93). As for the subtypes of side effects, multi-strain of Bifidobacterium infantis, Bifidobacterium longum, L. acidophilus, L. casei, Lactobacillus plantarum, Lactobacillus reuteri, L. rhamnosus, Lactobacillus salivarius, Lactobacillus sporogenes, and Streptococcus thermophilus was the best to reduce the incidence of diarrhea; multi-strain of Bacillus mesentericus, Clostridium butyricum, and Streptococcus faecalis for loss of appetite; multi-strain of B. longum, Lactobacillus bulgaricus, and S. thermophilus for constipation; multi-strain of Bifidobacterium bifidum, B. infantis, L. acidophilus, L. bulgaricus, L. casei, L. reuteri, and Streptococcus for taste disturbance; Saccharomyces boulardii for bloating; and multi-strain of Bifidobacterium breve, B. infantis, L. acidophilus, L. bulgaricus, L. casei, L. rhamnosus, and S. thermophilus for nausea/vomiting. CONCLUSIONS Probiotics are recommended to supplement triple therapy in pediatrics, and the effectiveness of triple therapy is associated with specific probiotic supplementation.
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Affiliation(s)
- Jue-Rong Feng
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Xiao Qiu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Lynne V McFarland
- Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Seattle, WA, 98115, USA
| | - Peng-Fei Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Department of Gastroenterology, The Central Hospital of Enshi Autonomous Prefecture, Enshi, China
| | - Rui Zhou
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Jing Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.
| | - Jin Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, No. 169, Donghu Road, Wuchang District, Wuhan, Hubei Province, 430071, China.
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Zhu XY, Liu F. Probiotics as an adjuvant treatment in Helicobacter pylori eradication therapy. J Dig Dis 2017; 18:195-202. [PMID: 28294543 DOI: 10.1111/1751-2980.12466] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Abstract
Over 80% of individuals infected with Helicobacter pylori (H. pylori) are asymptomatic. Increased resistance to antibiotics and decreased compliance to the therapeutic regimens have led to the failure of eradication therapy. Probiotics, with direct and indirect inhibitory effects on H. pylori in both animal models and clinical trials, have recently been used as a supplementary treatment in H. pylori eradication therapy. Probiotics have been considered useful because of the improvements in H. pylori eradication rates and therapy-related side effects although treatment outcomes using probiotics are controversial due to the heterogeneity of species, strains, doses and therapeutic duration of probiotics. Thus, despite the positive role of probiotics, several factors need to be further considered during their applications. Moreover, adverse events of probiotic use need to be noted. Further investigations into the safety of adjuvant probiotics to H. pylori eradication therapy are required.
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Affiliation(s)
- Xin Yan Zhu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fei Liu
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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