Efficacy and safety of probiotic-supplemented triple therapy for eradication of Helicobacter pylori in children: a systematic review and network meta-analysis
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The aim of this study was to identify the best probiotic supplementation in triple therapy for pediatric population with Helicobacter pylori infection.
Eligible trials were identified by comprehensive searches. Relative risks with 95% confidence intervals and relative ranks with P scores were assessed.
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.
Probiotics are recommended to supplement triple therapy in pediatrics, and the effectiveness of triple therapy is associated with specific probiotic supplementation.
KeywordsHelicobacter pylori Probiotics Children Safety Efficacy Network meta-analysis
Dr. Jue-Rong Feng and Dr. Fan Wang conceived and designed the search strategy, ran the searches, selected the studies, extracted the raw data, analyzed the data, and drafted and revised the manuscript.
Dr. Peng-Fei Chen and Dr. Rui Zhou independently assessed the risk of bias and checked the extracted data.
Professor Jing Liu and Dr. Xiao Qiu designed the data collection instruments; supervised the searches, data collection, and analysis; and critically reviewed the manuscript. Dr. Lynne V. McFarland provided the additional data and assisted with the manuscript writing.
Professor Qiu Zhao and Professor Jin Li conceptualized and designed the study, supervised the searches and data analysis, and revised the manuscript.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 9.Lu MH, Yu S, Deng JQ, Yan Q, Yang C, Xia GD, Zhou X (2016) Efficacy of probiotic supplementation therapy for Helicobacter pylori eradication: a meta-analysis of randomized controlled trials. PLoS One 11(10):26Google Scholar
- 14.McFarland LV, Malfertheiner P, Huang Y, Wang L (2015) Meta-analysis of single strain probiotics for the eradication of Helicobacter pylori and prevention of adverse events. World J Metaanal 3(2):97–117Google Scholar
- 20.Rucker G, Schwarzer G (2015) Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol 15–58Google Scholar
- 23.Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784CrossRefPubMedGoogle Scholar
- 24.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Li Z (2009) Efficacy of sequential triple therapy combined with probiotics in the treatment of Helicobacter pylori infection in children. Chin Prev Med 10(8):728–729Google Scholar
- 26.Pan TT, ZHU H, Lu H (2010) Clinical observation on the effect of probiotics in the treatment of Helicobacter pylori infection in children. Strait Pharma J 22(2):109–110Google Scholar
- 27.Wang WJ, Luo H, Wei J (2011) Effect of probiotics on Helicobacter pylori eradication in children with abdominal pain. Chin J Microecol 23(10):916–917Google Scholar
- 28.Zhang Y, Li J (2012) Effect of Saccharomyces boulardii on treatment of Helicobacter pylori infection in children of triple therapy. J Clin Pediatr 30(10):928–931Google Scholar
- 29.Zhou YJ (2012) Clinical observation of the effect of Helicobacter pylori eradication in children with Helicobacter pylori infection. Chin J Integr Trad West Med Dig 20(10):458–459Google Scholar
- 30.Yang Y, Huang J, Shao S (2013) Efficacy of probiotics combined with triple therapy in treatment of Helicobacter pylori infection in children. Chin J Nosocomiol 23(23):5757–5758Google Scholar
- 31.Zhang H (2013) Clinical effect about Boulardii powder combined triple therapy treating Helicobacter pylori infection in children. Medical J Chin People Health 25(1):38–40Google Scholar
- 32.He AZ (2014) Efficacy of probiotics combined with triple therapy in treatment of Helicobacter pylori infection in children. World Health Dig 14(19):122Google Scholar
- 33.Li M, Zhou X (2014) Efficacy of triple therapy combined with probiotics in the treatment of Helicobacter pylori infection in children. Modern J Integr Trad Chin West Med 23(26):2883–2884Google Scholar
- 34.Wang HJ, Feng D (2014) The effect of multi-drug combination in treatment of children with active gastric ulcer. Chin Med Herald 11(26):58–61Google Scholar
- 35.Yang XL (2014) The clinical trial on the eradication of Helicobacter pylori using probiotics with standard triple therapy on children. China Medical University, DissertationGoogle Scholar
- 36.Peng HM, Mei H, Wang B (2015) Efficacy of quadruple therapy containing probiotics on Helicobacter pylori. J Chin Physician 17(8):1249–1251Google Scholar
- 37.Sun BB (2015) Clinical effect of probiotics combined with triple therapy on Helicobacter pylori infection in children. Chin Med Herald 12(20):125–122Google Scholar
- 38.Zhong HZ, Ye Y, Lv B (2015) Clinical observation of the application of probiotics combined with triple therapy in the treatment of Helicobacter pylori infection in children. Chin Med Engineering 23(11):144–146Google Scholar
- 39.Fan J, Li M, Liao J (2016) Probiotics combined with triple therapy in the treatment of Helicobacter pylori infection in children. J Modern Clin Med 42(2):114–116Google Scholar
- 40.Xu LF, Yang X, Guo J (2016) Randomized controlled trial of Clostridium butyricum in eradication treatment of Helicobacter pylori infection in children. Chin J Microecol 28(4):413–416Google Scholar
- 41.Pan XL (2015) Effect of probiotics combined with triple therapy clinical value in treatment of Helicobacter pylori associated chronic gastritis. J Qiqihar University Med 36(24):3627–3629Google Scholar
- 42.Saneeyan H, Layegh S, Rahimi H (2011) Effectivness of probiotic on treatment of Helicobacter pylori infection in children. J Isfahan Med Sch 29(146):882–889Google Scholar
- 43.Sykora J, Valeckova K, Amlerova J, Siala K, Dedek P, Watkins S, Varvarovska J et al (2005) Effects of a specially designed fermented milk product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori in children: a prospective randomized double-blind study. J Clin Gastroenterol 39(8):692–698CrossRefPubMedGoogle Scholar
- 44.Szajewska H, Albrecht P, Topczewska-Cabanek A (2009) Randomized, double-blind, placebo-controlled trial: effect of Lactobacillus GG supplementation on Helicobacter pylori eradication rates and side effects during treatment in children. J Pediatr Gastroenterol Nutr 48(4):431–436CrossRefPubMedGoogle Scholar
- 48.Tolone S, Pellino V, Vitaliti G, Lanzafame A, Tolone C (2012) Evaluation of Helicobacter pylori eradication in pediatric patients by triple therapy plus lactoferrin and probiotics compared to triple therapy alone. Ital J Pediatr 38(63)Google Scholar
- 51.Plewińska EM, Płaneta-Małecka I, Bąk-Romaniszyn L, Małecka-Panas E (2006) Probiotics in the treatment of Helicobacter pylori infection in children. Gastroenterol Polska 13(4):315–319Google Scholar
- 54.Del Piano M, Anderloni A, Balzarini M, Ballare M, Carmagnola S, Montino F, Orsello M et al (2012) The innovative potential of Lactobacillus rhamnosus LR06, Lactobacillus pentosus LPS01, Lactobacillus plantarum LP01, and Lactobacillus delbrueckii subsp delbrueckii LDD01 to restore the “gastric barrier effect” in patients chronically treated with PPI: a pilot study. J Clin Gastroenterol 46(9):S18–S26CrossRefPubMedGoogle Scholar