Efficacy of Lactobacillus-supplemented triple therapy for Helicobacter pylori infection in children: a meta-analysis of randomized controlled trials

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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Abbreviations

CFU:

Colony-forming unit

CI:

Confidence interval

HpSA:

H. pylori stool antigen test

NSAID:

Nonsteroidal anti-inflammatory drug

RCT:

Randomized controlled trial

RR:

Relative risk

RUT:

Rapid urease test

PPI:

Proton pump inhibitor

UBT:

Urea breath test

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Contributions

H-RF: study design, search and selection of articles, data extraction, statistical analysis, drafting the manuscript; G-QZ: data extraction, quality assessment, statistical analysis, revising the manuscript; J-YC: search and selection of articles, quality assessment, statistical analysis; Z-YL: study design, statistical analysis, drafting, and revising the manuscript.

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Correspondence to Zhong-Yue Li.

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Communicated by Peter de Winter

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Fang, H., Zhang, G., Cheng, J. et al. Efficacy of Lactobacillus-supplemented triple therapy for Helicobacter pylori infection in children: a meta-analysis of randomized controlled trials. Eur J Pediatr 178, 7–16 (2019). https://doi.org/10.1007/s00431-018-3282-z

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Keywords

  • Lactobacillus
  • Triple therapy
  • H. pylori
  • Children
  • Meta-analysis