Efficacy and safety of probiotic-supplemented triple therapy for eradication of Helicobacter pylori in children: a systematic review and network meta-analysis

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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Author information

Affiliations

Authors

Contributions

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.

Corresponding authors

Correspondence to Qiu Zhao or Jin Li.

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The authors declare that they have no competing interests.

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Feng, JR., Wang, F., Qiu, X. et al. 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 73, 1199–1208 (2017). https://doi.org/10.1007/s00228-017-2291-6

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Keywords

  • Helicobacter pylori
  • Probiotics
  • Children
  • Safety
  • Efficacy
  • Network meta-analysis