Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis

source extracted confidence: high 2026-04-09
#humans #helicobacter-infections #probiotics #lactobacillus #randomized-controlled-trials-as-topic

Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis

Mishra et al., 2024 | Helicobacter | Meta Analysis

Citation

Mishra Vivek, Dash Debabrata, ... Pathak Sushil Kumar. Efficacy of Lactobacillus spp. Supplementation in Helicobacter pylori Eradication: A Systematic Meta-Analysis of Randomized Controlled Trials With Trial Sequential Analysis. Helicobacter. 2024;29(6):e70006. doi:10.1111/hel.70006

Abstract

BACKGROUND: Helicobacter pylori infection is a major global health concern and has been associated with a number of gastrointestinal disorders. Probiotics, especially Lactobacillus spp., have been suggested to have beneficial effect in managing H. pylori infection. This meta-analysis of randomized control trials (RCTs) aimed to evaluate the effect of Lactobacillus spp. supplementation on H. pylori eradication rates and associated side effects when combined with standard therapy. MATERIALS AND METHODS: Relevant studies were retrieved from PubMed, Scopus, Google Scholar and the Cochrane Library. Comprehensive Meta-Analysis (CMA) Software 4.0 was used for all the statistical analyses. TSA 0.9.5.10 Beta software was used for the trial sequential analysis (TSA). GRADEpro GDT was used to assess the certainty of evidence. RESULTS: An analysis of 26 selected studies showed that supplementing with Lactobacillus spp. significantly increased the rates of H. pylori eradication in per-protocol (PP) analysis (Overall risk ratio [RR] = 1.063, p = 0.000, 95% CI of -0.21 to 2.11; adults: RR = 1.050, p = 0.005, 95% CI = -0.55 to 2.03, children: RR = 1.223, p = 0.001, 95% CI = -13.35 to 4.55). In comparison to quadruple therapy, Lactobacillus spp. supplementation to triple therapy showed significant benefit (RR: 1.124; p = 0.000, 95% CI of -0.48 to 2.61). L. reuteri supplementation indicated better efficacy (RR: 1.049; p = 0.055, 95% CI of -0.56 to 3.26) than Lactobacillus GG (RR: 0.980; p = 0.595, 95% CI of -0.69 to 1.21). The 28-30 day (RR: 1.103; p = 0.003, 95% CI of -2.14 to 4.19) and 14-day supplementation periods (RR: 1.102; p = 0.003, 95% CI of -1.69 to 3.51) showed the most improvement. The analysis also revealed that Lactobacillus spp. significantly reduced gastrointestinal side effects: nausea/vomiting (RR: 0.566; p = 0.037, -3.11 to 1.45), diarrhea (RR: 0.324; p = 0.000, -5.46 to 0.48), and abdominal pain (RR: 0.438; p = 0.007, -5.65 to 4.22). The effect on bloating was non-significant (RR: 0.820; p = 0.498, -4.01 to 0.96). TSA graphs validated sufficient evidence for the conclusions. CONCLUSION: Lactobacillus spp. significantly enhances H. pylori eradication rates and may reduce gastrointestinal side effects when used alongside standard therapy, offering a promising adjunctive treatment option. The evidence was supported by TSA and assessed using GRADEpro, indicating a high certainty of the findings.

Key Findings

An analysis of 26 selected studies showed that supplementing with Lactobacillus spp. significantly increased the rates of H. pylori eradication in per-protocol (PP) analysis (Overall risk ratio [RR] = 1.063, p = 0.000, 95% CI of -0.21 to 2.11; adults: RR = 1.050, p = 0.005, 95% CI = -0.55 to 2.03, children: RR = 1.223, p = 0.001, 95% CI = -13.35 to 4.55). In comparison to quadruple therapy, Lactobacillus spp. supplementation to triple therapy showed significant benefit (RR: 1.124; p = 0.000, 95%

Outcomes Measured

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Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Helicobacter Infections
  • Probiotics
  • Lactobacillus
  • Randomized Controlled Trials as Topic
  • Helicobacter pylori
  • Treatment Outcome
  • Anti-Bacterial Agents
  • Dietary Supplements

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: probiotics

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09