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.	周本剛, 肖政, 汪成瓊, 等. 益生菌增效治療幽門螺桿菌感染的Meta分析再評價. 世界華人消化雜志, 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.	劉鵬飛, 沈衛東. 微生態制劑在幽門螺桿菌根除失敗后補救療法中的應用. 蘇州大學學報(醫學版), 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, 王伯軍. 含益生菌序貫療法作為根除幽門螺桿菌二線療法的臨床觀察. 浙江醫學, 2011, 33(2): 186-189.
14.	許亮, 許學新. 益生菌在治療難治性幽門螺桿菌感染中的價值. 臨床消化病雜志, 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.	王芳軍, 高籦, 劉鵬飛, 等. 復方嗜酸乳桿菌片在幽門螺桿菌根除失敗補救方案中作用的研究. 胃腸病學, 2014, 19(5): 284-287.
17.	劉霞, 何永紅, 劉海林, 等. 益生菌制劑在根除幽門螺桿菌初治失敗者的臨床療效觀察. 貴州醫藥, 2015, 39(1): 32-34.
18.	吳志芳, 趙暉, 鐘衛一, 等. 益生菌輔助多西環素補救方案根除幽門螺桿菌. 醫學理論與實踐, 2015, 28(21): 2883-2884.
19.	丁秋玲, 樸連花, 霍巖, 等. 復方嗜酸乳桿菌聯奏三聯療法治療幽門螺桿菌根除失敗患者的療效分析. 中國實用醫藥, 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, 吳麗麗, 張曉梅, 等. 微生態制劑對幽門螺桿菌感染的治療作用. 中華醫學雜志, 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.	中華醫學會消化病學分會幽門螺桿菌學組 /全國幽門螺桿菌研究協作組, 劉文忠, 謝勇, 等. 第四次全國幽門螺桿菌感染處理共識報告. 胃腸病學, 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. 周本剛, 肖政, 汪成瓊, 等. 益生菌增效治療幽門螺桿菌感染的Meta分析再評價. 世界華人消化雜志, 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. 劉鵬飛, 沈衛東. 微生態制劑在幽門螺桿菌根除失敗后補救療法中的應用. 蘇州大學學報(醫學版), 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, 王伯軍. 含益生菌序貫療法作為根除幽門螺桿菌二線療法的臨床觀察. 浙江醫學, 2011, 33(2): 186-189.
14. 許亮, 許學新. 益生菌在治療難治性幽門螺桿菌感染中的價值. 臨床消化病雜志, 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. 王芳軍, 高籦, 劉鵬飛, 等. 復方嗜酸乳桿菌片在幽門螺桿菌根除失敗補救方案中作用的研究. 胃腸病學, 2014, 19(5): 284-287.
17. 劉霞, 何永紅, 劉海林, 等. 益生菌制劑在根除幽門螺桿菌初治失敗者的臨床療效觀察. 貴州醫藥, 2015, 39(1): 32-34.
18. 吳志芳, 趙暉, 鐘衛一, 等. 益生菌輔助多西環素補救方案根除幽門螺桿菌. 醫學理論與實踐, 2015, 28(21): 2883-2884.
19. 丁秋玲, 樸連花, 霍巖, 等. 復方嗜酸乳桿菌聯奏三聯療法治療幽門螺桿菌根除失敗患者的療效分析. 中國實用醫藥, 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, 吳麗麗, 張曉梅, 等. 微生態制劑對幽門螺桿菌感染的治療作用. 中華醫學雜志, 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. 中華醫學會消化病學分會幽門螺桿菌學組 /全國幽門螺桿菌研究協作組, 劉文忠, 謝勇, 等. 第四次全國幽門螺桿菌感染處理共識報告. 胃腸病學, 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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