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

Research output: Contribution to journalReview articlepeer-review


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

METHODS: 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.

RESULTS: 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).

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

Original languageEnglish
Pages (from-to)139-149
Number of pages11
JournalWorld Journal of Gastroenterology
Issue number1
Publication statusPublished - Jan 7 2018


  • Adolescent
  • Adult
  • Aged
  • Breath Tests
  • Chi-Square Distribution
  • Child
  • Female
  • Helicobacter Infections/diagnosis
  • Helicobacter pylori/pathogenicity
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Probiotics/adverse effects
  • Risk Factors
  • Treatment Outcome
  • Young Adult


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