Meta-Analysis
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World J Gastroenterol. Dec 21, 2014; 20(47): 18013-18021
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.18013
Meta-analysis of the efficacy of probiotics in Helicobacter pylori eradication therapy
Rong Zhu, Kan Chen, Yuan-Yuan Zheng, Hua-Wei Zhang, Jun-Shan Wang, Yu-Jing Xia, Wei-Qi Dai, Fan Wang, Miao Shen, Ping Cheng, Yan Zhang, Cheng-Fen Wang, Jing Yang, Jing-Jing Li, Jie Lu, Ying-Qun Zhou, Chuan-Yong Guo
Rong Zhu, Kan Chen, Yuan-Yuan Zheng, Hua-Wei Zhang, Jun-Shan Wang, Yu-Jing Xia, Wei-Qi Dai, Fan Wang, Miao Shen, Ping Cheng, Yan Zhang, Cheng-Fen Wang, Jing Yang, Jing-Jing Li, Jie Lu, Ying-Qun Zhou, Chuan-Yong Guo, Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
Rong Zhu, Department of First Clinical Medical College, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
Author contributions: Zhu R, Chen K and Zheng YY contributed equally to this paper; Zhu R, Chen K, Zheng YY, Zhang HW and Wang JS designed the research; Zhu R, Chen K, Xia YJ, Dai WQ, Wang F, Shen M, Cheng P, Zhang Y and Wang CF performed the research; Yang J and Li JJ contributed new analytic tools; Zhu R, Chen K, Lu J and Zhou YQ analyzed the data; Zhu R, Chen K and Zheng YY wrote the paper; Guo CY accepts full responsibility for this paper.
Correspondence to: Chuan-Yong Guo, MD, Professor, Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Zhabei District, Shanghai 200072, China. guochuanyong@hotmail.com
Telephone: +86-21-66302535 Fax: +86-21-66303983
Received: April 20, 2014
Revised: June 28, 2014
Accepted: July 11, 2014
Published online: December 21, 2014
Abstract

AIM: To evaluate the role of probiotics in the standard triple Helicobacter pylori therapy.

METHODS: In this meta-analysis, we investigated the efficacy of probiotics in a standard triple H. pylori therapy in adults. Searches were mainly conducted in MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Fourteen studies met our criteria, and the quality of these studies was assessed using the Jadad scale. We used STATA version 12.0 to extract data and to calculate the odds ratios (ORs), which are presented with the corresponding 95% confidence intervals (CIs). The data are presented as forest plots.

RESULTS: The pooled ORs for the eradication rates calculated by intention-to-treat analysis and per-protocol analysis in the probiotic group vs the control group were 1.67 (95%CI: 1.38-2.02) and 1.68 (95%CI: 1.35-2.08), respectively, using the fixed-effects model. The sensitivity of the Asian studies was greater than that of the Caucasian studies (Asian: OR = 1.78, 95%CI: 1.40-2.26; Caucasian: OR = 1.48, 95%CI: 1.06-2.05). The pooled OR for the incidence of total adverse effects was significantly lower in the probiotic group (OR = 0.49, 95%CI: 0.26-0.94), using the random effects model, with significant heterogeneity (I2 = 85.7%). The incidence of diarrhea was significantly reduced in the probiotic group (OR = 0.21, 95%CI: 0.06-0.74), whereas the incidence of taste disorders, metallic taste, vomiting, nausea, and epigastric pain did not differ significantly between the probiotic group and the control group.

CONCLUSION: Supplementary probiotic preparations during standard triple H. pylori therapy may improve the eradication rate, particularly in Asian patients, and the incidence of total adverse effects.

Keywords: Helicobacter pylori, Eradication, Probiotics, Meta-analysis, Adult

Core tip: This systematic review and meta-analysis evaluated the role of probiotics in the standard triple Helicobacter pylori therapy in adults. Using a rigorous and rational search strategy, inclusion criteria, and statistical analyses, we found that supplementary probiotic preparations given during standard triple H. pylori therapy conferred a higher eradication rate, particularly in Asian patients, and a lower incidence of total adverse effects, particularly diarrhea.