Helicobacter pylori: triple therapy with probiotics versus triple therapy alone

Abstract

The treatment of H. pylori infection is becoming a challenge, due to a rise in antibiotic resistance. Although alternative treatments have been developed, standard triple therapy is still the most widely used first-line treatment. This dissertation is concerned with the efficacy of probiotic supplementation to standard triple therapy, when compared with standard triple therapy alone. The research question was formulated using the PICO framework as follows; “Is triple therapy in combination with probiotics (I) more effective than triple therapy alone (C) in eradicating Helicobacter pylori infection (O) in adults (P)?” An extensive search was carried out in eight databases. Only peer-reviewed studies, which were published in English and in the last ten years, were considered eligible. Moreover, they had to be human studies in adults over 18 years of age, and concerned with first-line standard triple therapy in combination with probiotics. Paediatric studies, animal studies, and in vitro studies were excluded, as well as studies which used other types of anti-H. pylori therapy. Only studies which ranked high in the hierarchy of evidence were considered. Six relevant studies were found; one systematic review with meta-analysis, and 5 RCTs, which were critically appraised using the CASP and AMSTAR checklists. The results show that probiotic supplementation in standard triple anti-H. pylori therapy is effective in improving treatment outcomes, however not all results were significant. Probiotics also seem to play a role in preventing treatment-related side effects. Whilst current evidence indicates that probiotics are a beneficial addition to triple therapy, further research is needed which investigates strain-specific choice of probiotic against H. pylori. The need to better address the potential benefits of probiotics when educating the general public, healthcare professionals, and students, was established. Recommendations for local practice and policy making, in terms of optimal treatment choices for H. pylori infection are put forward.