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Probiotics in Helicobacter pylori-induced peptic ulcer disease.

Abstract

The ideal treatment regimen for the eradication Helicobacter pylori infection has yet to be identified. Probiotics, particularly Lactobacillus, Bifidobacterium and Saccharomyces, have been suggested as adjuncts to antibiotics for the treatment of H. pylori. There is in vitro evidence that probiotics dampen the Th1 response triggered by H. pylori, attenuate H. pylori associated hypochlorhydria and secrete bacteriocidal metabolites. Probiotics interact with the innate host immune system through adherence to the gastric epithelium and secretion of bacterial adhesins. In prospective human studies, probiotic monotherapy effectively decrease H. pylori density (expired (13)CO2) by 2.0%-64.0%. Probiotic monotherapy has also been shown to eradicate H. pylori in up to 32.5%, although subsequent recrudescence is likely. Eleven meta-analyses have evaluated the efficacy of probiotics as adjuvants to antibiotics for the eradication of H. pylori. The addition of a probiotic increased treatment efficacy, OR 1.12-2.07. This benefit is probably strain-specific and may only be significant with relatively ineffective antibiotic regimens. The pooled prevalence of adverse effects was 12.9%-31.5% among subjects receiving adjuvant probiotics, compared with 24.3%-45.9% among controls. Diarrhea in particular was significantly reduced in subjects receiving adjuvant probiotics, compared with controls (OR 0.16-0.47). A reduction in adverse events other than diarrhea is variable. Despite the apparent benefit on efficacy and side effects conferred by probiotics, the optimal probiotic species, dose and treatment duration has yet to be determined. Further studies are needed to identify the probiotic, antibiotic and patient factors which might predict benefit from probiotic supplementation.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: dboltin@gmail.com.

    Source

    MeSH

    Anti-Bacterial Agents
    Gastrointestinal Microbiome
    Gastrointestinal Tract
    Helicobacter Infections
    Helicobacter pylori
    Humans
    Peptic Ulcer
    Probiotics
    Prospective Studies

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    27048901

    Citation

    Boltin, Doron. "Probiotics in Helicobacter Pylori-induced Peptic Ulcer Disease." Best Practice & Research. Clinical Gastroenterology, vol. 30, no. 1, 2016, pp. 99-109.
    Boltin D. Probiotics in Helicobacter pylori-induced peptic ulcer disease. Best Pract Res Clin Gastroenterol. 2016;30(1):99-109.
    Boltin, D. (2016). Probiotics in Helicobacter pylori-induced peptic ulcer disease. Best Practice & Research. Clinical Gastroenterology, 30(1), pp. 99-109. doi:10.1016/j.bpg.2015.12.003.
    Boltin D. Probiotics in Helicobacter Pylori-induced Peptic Ulcer Disease. Best Pract Res Clin Gastroenterol. 2016;30(1):99-109. PubMed PMID: 27048901.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Probiotics in Helicobacter pylori-induced peptic ulcer disease. A1 - Boltin,Doron, Y1 - 2015/12/18/ PY - 2015/11/23/received PY - 2015/12/10/revised PY - 2015/12/11/accepted PY - 2016/4/7/entrez PY - 2016/4/7/pubmed PY - 2016/9/23/medline KW - Antibiotics KW - Gastritis KW - Helicobacter pylori KW - Lactobacillus KW - Peptic ulcer disease KW - Probiotics SP - 99 EP - 109 JF - Best practice & research. Clinical gastroenterology JO - Best Pract Res Clin Gastroenterol VL - 30 IS - 1 N2 - The ideal treatment regimen for the eradication Helicobacter pylori infection has yet to be identified. Probiotics, particularly Lactobacillus, Bifidobacterium and Saccharomyces, have been suggested as adjuncts to antibiotics for the treatment of H. pylori. There is in vitro evidence that probiotics dampen the Th1 response triggered by H. pylori, attenuate H. pylori associated hypochlorhydria and secrete bacteriocidal metabolites. Probiotics interact with the innate host immune system through adherence to the gastric epithelium and secretion of bacterial adhesins. In prospective human studies, probiotic monotherapy effectively decrease H. pylori density (expired (13)CO2) by 2.0%-64.0%. Probiotic monotherapy has also been shown to eradicate H. pylori in up to 32.5%, although subsequent recrudescence is likely. Eleven meta-analyses have evaluated the efficacy of probiotics as adjuvants to antibiotics for the eradication of H. pylori. The addition of a probiotic increased treatment efficacy, OR 1.12-2.07. This benefit is probably strain-specific and may only be significant with relatively ineffective antibiotic regimens. The pooled prevalence of adverse effects was 12.9%-31.5% among subjects receiving adjuvant probiotics, compared with 24.3%-45.9% among controls. Diarrhea in particular was significantly reduced in subjects receiving adjuvant probiotics, compared with controls (OR 0.16-0.47). A reduction in adverse events other than diarrhea is variable. Despite the apparent benefit on efficacy and side effects conferred by probiotics, the optimal probiotic species, dose and treatment duration has yet to be determined. Further studies are needed to identify the probiotic, antibiotic and patient factors which might predict benefit from probiotic supplementation. SN - 1532-1916 UR - https://www.unboundmedicine.com/medline/citation/27048901/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-6918(15)00167-5 DB - PRIME DP - Unbound Medicine ER -