title: Pretreatment with Lactobacillus- and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy.
abstract: BACKGROUND
  Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) can suppress Helicobacter pylori. Improvement of the eradication rate by quadruple therapy of residual H. pylori after failed triple therapy is needed.
  
  
  OBJECTIVE
  We tested whether prior treatment with AB-yogurt improved the efficacy of quadruple therapy in eradicating residual H. pylori after failed triple therapy.
  
  
  METHODS
  One hundred thirty-eight patients in whom triple therapy failed were enrolled for a culture study of H. pylori to assess antimicrobial resistance. These patients were then randomly assigned in equal numbers to either a yogurt-plus-quadruple therapy group or a quadruple therapy-only group. The patients received 1 wk of quadruple therapy with or without a 4-wk pretreatment with AB-yogurt (400 mL/d). In the yogurt-plus-quadruple group, excessive delta(13)CO(2)/mL values of the (13)C-urea breath test were collected before and every 2 wk during the 4-wk ingestion of yogurt. For both groups, a (13)C-urea breath test was conducted > or =6 wk after the quadruple therapy to assess the outcome of residual H. pylori eradication.
  
  
  RESULTS
  For the patients in the yogurt-plus-quadruple therapy group infected with either antibiotic-sensitive or -resistant H. pylori, the excessive delta(13)CO(2)/mL values of the (13)C-urea breath test were significantly decreased after the 4-wk ingestion of AB-yogurt (P < 0.0001). The yogurt-plus-quadruple therapy group had a higher H. pylori eradication rate than did the quadruple therapy-only group (intention-to-treat analysis: 85% compared with 71.1%, P < 0.05; per-protocol analysis: 90.8% compared with 76.6%, P < 0.05).
  
  
  CONCLUSIONS
  A 4-wk pretreatment with AB-yogurt can decrease H. pylori loads despite antimicrobial resistance, thus improving the efficacy of quadruple therapy in eradicating residual H. pylori.
authors.affiliation: Department of Internal Medicine, Medical College, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 70428, Taiwan. sheubs@mail.ncku.edu.tw
authors.forename: Bor-Shyang
authors.initials: BS
authors.lastname: Sheu
authors.forename: Hsiu-Chi
authors.initials: HC
authors.lastname: Cheng
authors.forename: Ai-Wen
authors.initials: AW
authors.lastname: Kao
authors.forename: Shan-Tair
authors.initials: ST
authors.lastname: Wang
authors.forename: Yao-Jong
authors.initials: YJ
authors.lastname: Yang
authors.forename: Hsiao-Bai
authors.initials: HB
authors.lastname: Yang
authors.forename: Jiunn-Jong
authors.initials: JJ
authors.lastname: Wu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000898:Antibiosis; D001644:Bifidobacterium / Q000502:physiology*; D001944:Breath Tests; D002247:Carbon Isotopes; D003131:Combined Modality Therapy; D024881:Drug Resistance, Bacterial; D005260:Female; D016481:Helicobacter Infections / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000254:growth & development*; D006801:Humans; D007778:Lactobacillus / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D019936:Probiotics / Q000008:administration & dosage*; D016896:Treatment Outcome; D015014:Yogurt / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D002247:Carbon Isotopes