Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 139-149
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.139
Probiotic monotherapy and Helicobacter pylori eradication: A systematic review with pooled-data analysis
Giuseppe Losurdo, Rossella Cubisino, Michele Barone, Mariabeatrice Principi, Gioacchino Leandro, Enzo Ierardi, Alfredo Di Leo
Giuseppe Losurdo, Rossella Cubisino, Michele Barone, Mariabeatrice Principi, Enzo Ierardi, Alfredo Di Leo, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare, Bari 70124, Italy
Gioacchino Leandro, National Institute of Gastroenterology, “S De Bellis” Research Hospital, Via Turi, Castellana Grotte (BA) 70013, Italy
Author contributions: Losurdo G, Leandro G, Ierardi E and Di Leo A conceived the study; Losurdo G, Cubisino R, Barone M and Principi M collected the data; Losurdo G and Leandro G performed the statistical analysis; Losurdo G, Cubisino R and Ierardi E wrote the manuscript; All authors revised the manuscript and approved the final version.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Enzo Ierardi, MD, Professor, Section of Gastroenterology, Department of Emergency and Organ Transplantation, University “Aldo Moro”, Piazza Giulio Cesare 11, Bari 70124, Italy.
Telephone: +39-80-5593452 Fax: +39-80-5593088
Received: October 7, 2017
Peer-review started: October 9, 2017
First decision: October 25, 2017
Revised: November 13, 2017
Accepted: November 21, 2017
Article in press: November 21, 2017
Published online: January 7, 2018
Processing time: 91 Days and 18.1 Hours

To define probiotic monotherapy effect on Helicobacter pylori (H. pylori) status by performing a systematic review.


Methods of analysis and inclusion criteria were based on PRISMA recommendations. Relevant publications were identified by searching PubMed, MEDLINE, Science Direct, and EMBASE. The end-point was to estimate eradication rate and urea breath test delta value before and after probiotic monotherapy across all studies and, overall, with a pooled data analysis. Adverse events of probiotic therapy were evaluated. The data were expressed as proportions/percentages, and 95%CIs were calculated. For continuous variables, we evaluated the weighted mean difference. Odd ratios (ORs) were calculated according to the Peto method for the comparison of eradication rates between probiotics and placebo.


Eleven studies were selected. Probiotics eradicated H. pylori in 50 out of 403 cases. The mean weighted eradication rate was 14% (95%CI: 2%-25%, P = 0.02). Lactobacilli eradicated the bacterium in 30 out of 235 patients, with a mean weighted rate of 16% (95%CI: 1%-31%). Saccharomyces boulardii achieved eradication in 6 out of 63 patients, with a pooled eradication rate of 12% (95%CI: 0%-29%). Multistrain combinations were effective in 14 out of 105 patients, with a pooled eradication rate of 14% (95%CI: 0%-43%). In the comparison of probiotics vs placebo, we found an OR of 7.91 in favor of probiotics (95%CI: 2.97-21.05, P < 0.001). Probiotics induced a mean reduction in delta values higher than placebo (8.61% with a 95%CI: 5.88-11.34, vs 0.19% for placebo, P < 0.001). Finally, no significant difference in adverse events was found between probiotics and placebo (OR = 1, 95%CI: 0.06-18.08).


Probiotics alone show a minimal effect on H. pylori clearance, thus suggesting a likely direct role.

Keywords: Helicobacter pylori, Probiotics, Eradication, Meta-analysis, Breath test

Core tip: Despite several lines of evidence in the literature having demonstrated a pivotal role of probiotics as adjunctive treatment for Helicobacter pylori (H. pylori) eradication, national and international guidelines do not have a uniform consensus about their clinical application. Many meta-analyses have confirmed that co-administration of probiotics may have a beneficial effect on the prevention of side effects and eradication rates. Herein, we found that probiotic monotherapy may eradicate H. pylori in 14% of cases. Lactobacilli, Saccharomyces boulardii and multistrain combinations eradicated the bacterium with a rate of 16%, 12% and 14%, respectively. Probiotics were significantly more effective than placebo (OR = 7.91).