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The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: a meta-analysis.

Dang Y, Reinhardt JD, Zhou X, Zhang G - PLoS ONE (2014)

Bottom Line: Previous meta-analyses reported that probiotics improve the effectiveness of Helicobacter pylori (H. pylori) eradication during antibiotic therapy, while results regarding a possible reduction of side effects remained inconclusive.It is further conceivable that probiotics will produce additional effects only if antibiotics are relatively ineffective.There was a significant difference between groups in the overall incidence of side effects (RR 0.735, 95% CI 0.598-0.902).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, and First Clinical Medical College of Nanjing Medical University, Nanjing, China.

ABSTRACT

Background: Previous meta-analyses reported that probiotics improve the effectiveness of Helicobacter pylori (H. pylori) eradication during antibiotic therapy, while results regarding a possible reduction of side effects remained inconclusive. Moreover, the effectiveness of different strains of probiotics has not been studied so far. It is further conceivable that probiotics will produce additional effects only if antibiotics are relatively ineffective.

Methods: This meta-analysis includes eligible randomized controlled trials examining effects of probiotics supplementation on eradication rates (ER) and side effects, published up to May 2014. Sub-group analysis was performed to compare different probiotic strains and antibiotic therapies with different effectiveness in controls (ER <80% vs.>80%). Publication bias was assessed with funnel plots and Harbord's test. The quality of the trials was assessed with the Cochrane risk of bias tool.

Results: Thirty-three RCTs involving a total of 4459 patients met the inclusion criteria in case of eradication rates of which 20 assessed total side effects in addition. Overall, the pooled eradication rate in probiotics supplementation groups was significantly higher than in controls (ITT analysis: RR 1.122, 95% CI 1.086-1.159, PP analysis: RR 1.114, 95% CI 1.070-1.159). Sub group-analysis could, however, confirm this finding only for four individual strains (Lactobacillus acidophilus, Lactobacillus casei DN-114001, Lactobacillus gasseri, and Bifidobacterium infantis 2036) and for relatively ineffective antibiotic therapies. There was a significant difference between groups in the overall incidence of side effects (RR 0.735, 95% CI 0.598-0.902). This result was, however, only confirmed for non-blinded trials.

Conclusions: The pooled data suggest that supplementation with specific strains of probiotics compared with eradication therapy may be considered an option for increasing eradication rates, particularly when antibiotic therapies are relatively ineffective. The impact on side effects remains unclear and more high quality trials on specific probiotic strains and side effects are thus needed.

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Funnel plot analysis of publication bias for side effects.
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pone-0111030-g006: Funnel plot analysis of publication bias for side effects.

Mentions: There were 20 trials (2487 patients, 1269 in the probiotics supplementation group and 1218 in the control group) which provided data on the overall incidence of side effects. Significant heterogeneity was found for the overall occurrence of side effects (I2 = 72.2%, P<0.001). Therefore, the random effects model was used. The pooled RR in the probiotics supplementation over control was 0.735 (95% CI 0.598–0.902) (Figure 5). While Harbord's modified test for publication bias was insignificant (p = 0.17), the Funnel Plot did reveal some asymmetry (Figure 6): Small studies showing a considerable reduction in side-effects occur more often than those only showing a small reduction. When stratified by probiotics, only the pooled RR for Saccharomyces boulardii indicates a significant reduction in side effects (0.335, 95% CI 0.220–0.510; LB: 0.892, 95% CI 0.632–1.259; MS: 0.760, 95% CI 0.568–1.017; BB: 0.895: 0.737–1.087).


The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: a meta-analysis.

Dang Y, Reinhardt JD, Zhou X, Zhang G - PLoS ONE (2014)

Funnel plot analysis of publication bias for side effects.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4217763&req=5

pone-0111030-g006: Funnel plot analysis of publication bias for side effects.
Mentions: There were 20 trials (2487 patients, 1269 in the probiotics supplementation group and 1218 in the control group) which provided data on the overall incidence of side effects. Significant heterogeneity was found for the overall occurrence of side effects (I2 = 72.2%, P<0.001). Therefore, the random effects model was used. The pooled RR in the probiotics supplementation over control was 0.735 (95% CI 0.598–0.902) (Figure 5). While Harbord's modified test for publication bias was insignificant (p = 0.17), the Funnel Plot did reveal some asymmetry (Figure 6): Small studies showing a considerable reduction in side-effects occur more often than those only showing a small reduction. When stratified by probiotics, only the pooled RR for Saccharomyces boulardii indicates a significant reduction in side effects (0.335, 95% CI 0.220–0.510; LB: 0.892, 95% CI 0.632–1.259; MS: 0.760, 95% CI 0.568–1.017; BB: 0.895: 0.737–1.087).

Bottom Line: Previous meta-analyses reported that probiotics improve the effectiveness of Helicobacter pylori (H. pylori) eradication during antibiotic therapy, while results regarding a possible reduction of side effects remained inconclusive.It is further conceivable that probiotics will produce additional effects only if antibiotics are relatively ineffective.There was a significant difference between groups in the overall incidence of side effects (RR 0.735, 95% CI 0.598-0.902).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, and First Clinical Medical College of Nanjing Medical University, Nanjing, China.

ABSTRACT

Background: Previous meta-analyses reported that probiotics improve the effectiveness of Helicobacter pylori (H. pylori) eradication during antibiotic therapy, while results regarding a possible reduction of side effects remained inconclusive. Moreover, the effectiveness of different strains of probiotics has not been studied so far. It is further conceivable that probiotics will produce additional effects only if antibiotics are relatively ineffective.

Methods: This meta-analysis includes eligible randomized controlled trials examining effects of probiotics supplementation on eradication rates (ER) and side effects, published up to May 2014. Sub-group analysis was performed to compare different probiotic strains and antibiotic therapies with different effectiveness in controls (ER <80% vs.>80%). Publication bias was assessed with funnel plots and Harbord's test. The quality of the trials was assessed with the Cochrane risk of bias tool.

Results: Thirty-three RCTs involving a total of 4459 patients met the inclusion criteria in case of eradication rates of which 20 assessed total side effects in addition. Overall, the pooled eradication rate in probiotics supplementation groups was significantly higher than in controls (ITT analysis: RR 1.122, 95% CI 1.086-1.159, PP analysis: RR 1.114, 95% CI 1.070-1.159). Sub group-analysis could, however, confirm this finding only for four individual strains (Lactobacillus acidophilus, Lactobacillus casei DN-114001, Lactobacillus gasseri, and Bifidobacterium infantis 2036) and for relatively ineffective antibiotic therapies. There was a significant difference between groups in the overall incidence of side effects (RR 0.735, 95% CI 0.598-0.902). This result was, however, only confirmed for non-blinded trials.

Conclusions: The pooled data suggest that supplementation with specific strains of probiotics compared with eradication therapy may be considered an option for increasing eradication rates, particularly when antibiotic therapies are relatively ineffective. The impact on side effects remains unclear and more high quality trials on specific probiotic strains and side effects are thus needed.

Show MeSH
Related in: MedlinePlus