title: Emerging Role of Probiotics in the Management of Helicobacter pylori Infection: Histopathologic Perspectives.
abstract: BACKGROUND
  There is growing evidence from preclinical and clinical studies that emphasizes the efficacy of probiotics in the management of Helicobacter (H) pylori infection; it increased the eradication rate, improved patient clinical manifestations and lowered treatment associated side effects.
  
  
  OBJECTIVE
  In this review we documented the potential ability of probiotics to ameliorate H. pylori induced histological features.
  
  
  METHODS
  We searched the available literature for full length articles focusing the role of probiotics on H. pylori induced gastritis from histologic perspectives.
  
  
  RESULTS
  Probiotics lowered H. pylori density at the luminal side of epithelium, improved histological inflammatory and activity scores both in the gastric corpus and antrum. This effect persists for long period of time after discontinuation of probiotic supplementation and this is probably through an immune mechanism.
  
  
  CONCLUSIONS
  The current evidence support the promising role of probiotics in improving H. pylori induced histopathological features both in gastric antrum and corpus and for long periods of time. Because increased density of H. pylori on the gastric mucosa is linked to more severe gastritis and increased incidence of peptic ulcers, we can infer that a reduction of the density might help to decrease the risk of developing pathologies, probably the progression toward atrophic gastritis and gastric adenocarcinoma. These effects together with improving the H. pylori eradication rates and amelioration of treatment related side effects might open the door for probiotics to be added to H. pylori eradication regimens.
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
authors.forename: Mohamed H
authors.identifier: http://orcid.org/0000-0002-1504-7851
authors.initials: MH
authors.lastname: Emara
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
authors.forename: Soha A
authors.initials: SA
authors.lastname: Elhawari
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Salem
authors.initials: S
authors.lastname: Yousef
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
authors.forename: Mohamed I
authors.initials: MI
authors.lastname: Radwan
authors.affiliation: Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
authors.forename: Hesham R
authors.initials: HR
authors.lastname: Abdel-Aziz
mesh_terms: D000818:Animals; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects / Q000502:physiology; D006801:Humans; D019936:Probiotics / Q000008:administration & dosage*
keywords: Helicobacter pylori; Probiotics; gastric activity score; gastric inflammatory cell score; gastritis; sydney classification system