The Effect of Quadruple Therapy Plus Probiotics on Helicobacter Pylori Eradication and Antibiotic-Associated Side Effects: A Randomized Placebo-Controlled Trial

Abstract

Background: Helicobacter pylori (H. pylori) induces gastric mucosal inflammation, which may lead to chronic gastritis and gastric ulcer, gastric adenocarcinoma, or mucosa-associated lymphoid tissue (MALT) lymphoma. Managing H. pylori-related complications requires H. pylori eradication. Probiotics are one of the potential supplements that can be effective against H. pylori infection by stabilizing or restoring endogenous physiological flora and preventing H. pylori growth. Objectives: The study aimed to evaluate the effectiveness of a quadruple regimen for H. pylori eradication plus probiotic supplementation. Methods: This randomized placebo-controlled trial was at a gastroenterology clinic in Kermanshah, Iran. A total of 142 H. pylori-positive subjects were randomized into either 10-day quadruple therapy (amoxicillin+ metronidazole+ pantoprazole + bismuth salt) plus placebo or quadruple therapy plus probiotic. H. pylori eradication was evaluated using a stool antigen test six weeks after treatment. The side effects of the treatment were recorded in both groups. Results: A total of three and five patients in the probiotics and placebo group did not complete the treatment or follow-up, respectively. The rate of H. pylori eradication was 44.1 and 34.8% for probiotic and placebo groups, respectively (P = 0.27). At the end of the trial, a lower rate of nausea (P = 0.004), taste disturbance (P = 0.002), headache/dizziness (P = 0.002), and flatulence/epigastric pain (P = 0.004) were recorded in the probiotic group compared to the placebo group. Conclusions: Based on the results, probiotics can be somewhat effective in eradicating H. pylori infection. Probiotic adjunctive therapy is suggested to relieve gastrointestinal symptoms when receiving antibiotic therapy.