Probiotics-containing Rescue Regimen for the Eradication of Helicobacter Pylori Infection: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHOUBen-gang ¹ , CHENG-jiao ¹ , LIUMei ¹ , GUOPeng ² , XIAOZheng ³ ,  CHENAn-hai ¹

1. Department of Gastroenterology, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China;
2. Department of Hepatobiliary Surgery, People's Hospital of Hubei University of Medicine, Shiyan 442000, China;
3. Evidence-Based Medicine Center, Affiliated Hospital of Zunyi Medical College, MOE Virtual Research Center of Evidence-Based Medicine at Zunyi Medical College, Zunyi 563003, China;

Corresponding author：

CHENAn-hai, Email: 490027214@qq.com

Keywords：

Probiotics; Helicobacter pylori; Rescue therapy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160085

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Objective To systematically review the efficacy and safety of probiotics-containing rescue regimen for the eradication of Helicobacter pylori (Hp) infection. Methods We electronically searched PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CBM, CNKI, WanFang Data and VIP databases, and Chinese Clinical Trial Register (ChiCTR) and ClinicalTrial.gov from inception to December 2015, to collect randomized controlled trials (RCTs) about probiotics-containing rescue regimen for the eradication of Hp infection. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. Results Eleven RCTs involving 1888 patients were finally included. The results of meta-analysis showed that: Compared with the control group, probiotics-containing rescue regimen could significantly increase the eradication rate (ITT analysis: 80.3% vs. 69.3%, RR =1.15, 95%CI 1.10 to 1.22, P<0.00001; PP analysis: 86.5% vs. 74.3%, RR=1.16, 95%CI 1.11 to 1.22, P<0.00001), and decrease the incidence of total adverse reaction (ITT analysis: 19% vs. 29.2%, RR=0.60, 95%CI 0.40 to 0.91, P=0.02). Sensitivity analysis showed that the result was relatively stable. Publication bias test showed no evidence of substantial publication bias. Conclusion Current evidence indicates that probiotics-containing rescue regimen may contribute to improve eradication rate of Hp infection patients, and may reduce the occurrence of major gastrointestinal associated adverse reaction. Due to the limited quality and quantity of included studies, more high-quality RCTs are needed to verify the above conclusion.

Citation： ZHOUBen-gang, CHENG-jiao, LIUMei, GUOPeng, XIAOZheng, CHENAn-hai. Probiotics-containing Rescue Regimen for the Eradication of Helicobacter Pylori Infection: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2016, 16(5): 550-556. doi: 10.7507/1672-2531.20160085 Copy

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2.	Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection——the Maastricht IV/Florence Consensus Report. Gut, 2012, 61(5): 646-664.
3.	Sugano K, Tack J, Kuipers E J, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut, 2015, 64(9): 1353-1367.
4.	周本刚, 肖政, 汪成琼, 等. 益生菌增效治疗幽门螺杆菌感染的Meta分析再评价. 世界华人消化杂志, 2015, 23(20): 3326-3336.
5.	Lv Z, Wang B, Zhou X, et al. Efficacy and safety of probiotics as adjuvant agents for infection: A meta-analysis. Exp Ther Med, 2015, 9(3): 707-716.
6.	Dang Y, Reinhardt J D, Zhou X, et al. The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: a meta-analysis. PLOS One, 2014, 9(11): e111030.
7.	Zheng X, Lyu L, Mei Z. Lactobacillus-containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis. Rev Esp Enferm Dig, 2013, 105(8): 445-453.
8.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane.org/training/cochrane-handbook.
9.	Tursi A, Brandimarte G, Giorgetti G M, et al. Effect of Lactobacillus casei supplementation on the effectiveness and tolerability of a new second-line 10-day quadruple therapy after failure of a first attempt to cure Helicobacter pylori infection. Med Sci Monit, 2004, 10(12): R662-R666.
10.	Sheu B S, Cheng H C, Kao A W, et al. Pretreatment with Lactobacillus-and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy. Am J Clin Nutr, 2006, 83(4): 864-869.
11.	刘鹏飞, 沈卫东. 微生态制剂在幽门螺杆菌根除失败后补救疗法中的应用. 苏州大学学报(医学版), 2009, 29(6): 1152-1154.
12.	Yoon H, Kim N, Kim J Y, et al. Effects of multistrain probiotic-containing yogurt on second-line triple therapy for Helicobacter pylori infection. J Gastroen and Hepatol, 2011, 26(1): 44-48.
13.	胡桂梅, 王伯军. 含益生菌序贯疗法作为根除幽门螺杆菌二线疗法的临床观察. 浙江医学, 2011, 33(2): 186-189.
14.	许亮, 许学新. 益生菌在治疗难治性幽门螺杆菌感染中的价值. 临床消化病杂志, 2012, 24(4): 218-219.
15.	Ojetti V, Bruno G, Ainora M E, et al. Impact of Lactobacillus reuteri Supplementation on Anti-Helicobacterpylori Levofloxacin-Based Second-Line Therapy. Gastroent Res and Pract, 2012, 2012: 740381.
16.	王芳军, 高籦, 刘鹏飞, 等. 复方嗜酸乳杆菌片在幽门螺杆菌根除失败补救方案中作用的研究. 胃肠病学, 2014, 19(5): 284-287.
17.	刘霞, 何永红, 刘海林, 等. 益生菌制剂在根除幽门螺杆菌初治失败者的临床疗效观察. 贵州医药, 2015, 39(1): 32-34.
18.	吴志芳, 赵晖, 钟卫一, 等. 益生菌辅助多西环素补救方案根除幽门螺杆菌. 医学理论与实践, 2015, 28(21): 2883-2884.
19.	丁秋玲, 朴连花, 霍岩, 等. 复方嗜酸乳杆菌联奏三联疗法治疗幽门螺杆菌根除失败患者的疗效分析. 中国实用医药, 2015, 10(11): 161-162.
20.	Homan M, Orel R. Are probiotics useful in Helicobacter pylori eradication? World J Gastroenterol, 2015, 21(37): 10644-10653.
21.	曾冉冉, 吴丽丽, 张晓梅, 等. 微生态制剂对幽门螺杆菌感染的治疗作用. 中华医学杂志, 2015, 95(16): 1266-1267.
22.	Ruggiero P. Use of probiotics in the fight against Helicobacter pylori. World J Gastrointest Pathophysiol, 2014, 5(4): 384-391.
23.	Bian Z, Liu B, Moher D, et al. Consolidated standards of reporting trials (CONSORT) for traditional Chinese medicine: current situation and future development. Front Med, 2011, 5(2): 171-177.
24.	中华医学会消化病学分会幽门螺杆菌学组 /全国幽门螺杆菌研究协作组, 刘文忠, 谢勇, 等. 第四次全国幽门螺杆菌感染处理共识报告. 胃肠病学, 2012, 17(10): 618-625.

1. Georgopoulos S D, Papastergiou V, Karatapanis S. Treatment of Helicobacter Pylori infection: optimization strategies in a high resistance era. Expert Opin Pharmacother, 2015, 16(15): 2307-2317.
2. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection——the Maastricht IV/Florence Consensus Report. Gut, 2012, 61(5): 646-664.
3. Sugano K, Tack J, Kuipers E J, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut, 2015, 64(9): 1353-1367.
4. 周本刚, 肖政, 汪成琼, 等. 益生菌增效治疗幽门螺杆菌感染的Meta分析再评价. 世界华人消化杂志, 2015, 23(20): 3326-3336.
5. Lv Z, Wang B, Zhou X, et al. Efficacy and safety of probiotics as adjuvant agents for infection: A meta-analysis. Exp Ther Med, 2015, 9(3): 707-716.
6. Dang Y, Reinhardt J D, Zhou X, et al. The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: a meta-analysis. PLOS One, 2014, 9(11): e111030.
7. Zheng X, Lyu L, Mei Z. Lactobacillus-containing probiotic supplementation increases Helicobacter pylori eradication rate: evidence from a meta-analysis. Rev Esp Enferm Dig, 2013, 105(8): 445-453.
8. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane.org/training/cochrane-handbook.
9. Tursi A, Brandimarte G, Giorgetti G M, et al. Effect of Lactobacillus casei supplementation on the effectiveness and tolerability of a new second-line 10-day quadruple therapy after failure of a first attempt to cure Helicobacter pylori infection. Med Sci Monit, 2004, 10(12): R662-R666.
10. Sheu B S, Cheng H C, Kao A W, et al. Pretreatment with Lactobacillus-and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy. Am J Clin Nutr, 2006, 83(4): 864-869.
11. 刘鹏飞, 沈卫东. 微生态制剂在幽门螺杆菌根除失败后补救疗法中的应用. 苏州大学学报(医学版), 2009, 29(6): 1152-1154.
12. Yoon H, Kim N, Kim J Y, et al. Effects of multistrain probiotic-containing yogurt on second-line triple therapy for Helicobacter pylori infection. J Gastroen and Hepatol, 2011, 26(1): 44-48.
13. 胡桂梅, 王伯军. 含益生菌序贯疗法作为根除幽门螺杆菌二线疗法的临床观察. 浙江医学, 2011, 33(2): 186-189.
14. 许亮, 许学新. 益生菌在治疗难治性幽门螺杆菌感染中的价值. 临床消化病杂志, 2012, 24(4): 218-219.
15. Ojetti V, Bruno G, Ainora M E, et al. Impact of Lactobacillus reuteri Supplementation on Anti-Helicobacterpylori Levofloxacin-Based Second-Line Therapy. Gastroent Res and Pract, 2012, 2012: 740381.
16. 王芳军, 高籦, 刘鹏飞, 等. 复方嗜酸乳杆菌片在幽门螺杆菌根除失败补救方案中作用的研究. 胃肠病学, 2014, 19(5): 284-287.
17. 刘霞, 何永红, 刘海林, 等. 益生菌制剂在根除幽门螺杆菌初治失败者的临床疗效观察. 贵州医药, 2015, 39(1): 32-34.
18. 吴志芳, 赵晖, 钟卫一, 等. 益生菌辅助多西环素补救方案根除幽门螺杆菌. 医学理论与实践, 2015, 28(21): 2883-2884.
19. 丁秋玲, 朴连花, 霍岩, 等. 复方嗜酸乳杆菌联奏三联疗法治疗幽门螺杆菌根除失败患者的疗效分析. 中国实用医药, 2015, 10(11): 161-162.
20. Homan M, Orel R. Are probiotics useful in Helicobacter pylori eradication? World J Gastroenterol, 2015, 21(37): 10644-10653.
21. 曾冉冉, 吴丽丽, 张晓梅, 等. 微生态制剂对幽门螺杆菌感染的治疗作用. 中华医学杂志, 2015, 95(16): 1266-1267.
22. Ruggiero P. Use of probiotics in the fight against Helicobacter pylori. World J Gastrointest Pathophysiol, 2014, 5(4): 384-391.
23. Bian Z, Liu B, Moher D, et al. Consolidated standards of reporting trials (CONSORT) for traditional Chinese medicine: current situation and future development. Front Med, 2011, 5(2): 171-177.
24. 中华医学会消化病学分会幽门螺杆菌学组 /全国幽门螺杆菌研究协作组, 刘文忠, 谢勇, 等. 第四次全国幽门螺杆菌感染处理共识报告. 胃肠病学, 2012, 17(10): 618-625.

Chinese Journal of Evidence-Based Medicine

Probiotics-containing Rescue Regimen for the Eradication of Helicobacter Pylori Infection: A Systematic Review

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