A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Benefits of Using Lactobacillus Supplements as an Adjunct Treatment for Helicobacter pylori Eradication

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

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Benefits of Using Lactobacillus Supplements as an Adjunct Treatment for Helicobacter pylori Eradication

Azam et al., 2025 | Microbiologyopen | Meta Analysis

Citation

Azam Asma, Qureshi Muhammad Abdul Muqtadir, ... Waheed Abdul. A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Benefits of Using Lactobacillus Supplements as an Adjunct Treatment for Helicobacter pylori Eradication. Microbiologyopen. 2025-Dec;14(6):e70166. doi:10.1002/mbo3.70166

Abstract

Supplementing H. pylori treatment with probiotics like Lactobacillus has become an essential approach due to the possible adverse effects of antibiotic therapy and the need to increase overall eradication rates. Although several types of Lactobacillus strains as probiotics were efficient in treating H. pylori, their relative efficiency in treating H. pylori was uncertain. A survey of databases, including PubMed, Cochrane, Google Scholar, Scopus, and Clinicaltrials.gov, retrieved 52 Randomized Controlled Trials (RCTs), with 14 meeting the criteria for RCTs on Lactobacillus supplementation (LS) as an adjunct therapy compared to placebo in adult H. pylori patients. Analyses were conducted using RevMan5.3, Cochrane Risk of Bias Tool, Comprehensive Meta-Analysis Software, and GRADEpro. Fourteen RCTs, including 2054 patients with more than ten different probiotics, were included in this analysis. The LS group showed significantly higher H. pylori eradication rates [RR = 1.04 (95% CI: 1.01, 1.07; p = 0.009; I2 = 0%); (high certainty)], decreased AEs including vomiting [RR = 0.82 (95% CI: 0.48, 1.41; p = 0.48; I2 = 19%); (high certainty)], diarrhea [RR = 0.45 (95% CI: 0.26, 0.80; p = 0.007; I² = 55%); (high certainty)], abdominal pain [RR = 0.73 (95% CI: 0.28, 1.93; p = 0.53; I² = 66%); (high certainty)], anorexia [RR = 0.79 (95% CI: 0.23, 2.64; p = 0.70; I² = 0%); (high certainty)], constipation [RR = 1.02 (95% CI: 0.42, 2.50; p = 0.96; I² = 0%); (high certainty)], rash [RR = 1.51 (95% CI: 0.57, 3.98; p = 0.41; I² = 0%); (high certainty)], taste disturbance [RR = 0.64 (95% CI: 0.44, 0.92; p = 0.02; I² = 51%); (moderate certainty)], and reduction of gastrointestinal symptoms including abdominal pain [SMD = -0.19 (95% CI: -0.46, 0.09; p = 0.18; I² = %); (moderate certainty)]. None of the included RCTs depicted a high risk of bias. Lactobacillus added to triple or quadruple therapy increased eradication rates, but improvements in adverse effects and gastrointestinal symptoms were not significant. Multiple different strains limited assessment of individual effectiveness, preventing firm conclusions about the specific impact of each Lactobacillus type.

Key Findings

Multiple different strains limited assessment of individual effectiveness, preventing firm conclusions about the specific impact of each Lactobacillus type.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population adult h
Sample Size 2054
Age Range See abstract
Condition See abstract

MeSH Terms

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

Evidence Classification

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

Provenance

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