title: Probiotics in Helicobacter pylori eradication therapy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To summarize the evidence from randomized controlled trials (RCTs) regarding the effect of probiotics by using a meta-analytic approach.
  
  
  METHODS
  In July 2013, we searched PubMed, EMBASE, Ovid, the Cochrane Library, and three Chinese databases (Chinese Biomedical Literature Database, Chinese Medical Current Content, and Chinese Scientific Journals database) to identify relevant RCTs. We included RCTs investigating the effect of a combination of probiotics and standard therapy (probiotics group) with standard therapy alone (control group). Risk ratios (RRs) were used to measure the effect of probiotics plus standard therapy on Helicobacter pylori (H. pylori) eradication rates, adverse events, and patient compliance using a random-effect model.
  
  
  RESULTS
  We included data on 6997 participants from 45 RCTs, the overall eradication rates of the probiotic group and the control group were 82.31% and 72.08%, respectively. We noted that the use of probiotics plus standard therapy was associated with an increased eradication rate by per-protocol set analysis (RR = 1.11; 95%CI: 1.08-1.15; P < 0.001) or intention-to-treat analysis (RR = 1.13; 95%CI: 1.10-1.16; P < 0.001). Furthermore, the incidence of adverse events was 21.44% in the probiotics group and 36.27% in the control group, and it was found that the probiotics plus standard therapy significantly reduced the risk of adverse events (RR = 0.59; 95%CI: 0.48-0.71; P < 0.001), which demonstrated a favorable effect of probiotics in reducing adverse events associated with H. pylori eradication therapy. The specific reduction in adverse events ranged from 30% to 59%, and this reduction was statistically significant. Finally, probiotics plus standard therapy had little or no effect on patient compliance (RR = 0.98; 95%CI: 0.68-1.39; P = 0.889).
  
  
  CONCLUSIONS
  The use of probiotics plus standard therapy was associated with an increase in the H. pylori eradication rate, and a reduction in adverse events resulting from treatment in the general population. However, this therapy did not improve patient compliance.
authors.affiliation: Min-Min Zhang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Min-Min
authors.initials: MM
authors.lastname: Zhang
authors.affiliation: Min-Min Zhang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qian
authors.affiliation: Min-Min Zhang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Ying-Yi
authors.initials: YY
authors.lastname: Qin
authors.affiliation: Min-Min Zhang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Jia
authors.initials: J
authors.lastname: He
authors.affiliation: Min-Min Zhang, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Yu-Hao
authors.initials: YH
authors.lastname: Zhou
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D016480:Helicobacter pylori / Q000187:drug effects / Q000254:growth & development*; D006801:Humans; D016017:Odds Ratio; D010349:Patient Compliance; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Eradication; Helicobacter pylori; Meta-analysis; Probiotics; Systematic review