title: Effect of Pretreatment with Lactobacillus delbrueckii and Streptococcus thermophillus on Tailored Triple Therapy for Helicobacter pylori Eradication: A Prospective Randomized Controlled Clinical Trial.
abstract: BACKGROUND
  Helicobacter pylori plays an important role in gastric cancer and typical eradication regimens are no longer effective in many countries, including Thailand. The aim of our study was to compare the effect of Lactobacillus delbrueckii and Streptococcus thermophillus on tailored triple therapy for Helicobacter pylori eradication.
  
  
  METHODS
  This prospective single-center study was conducted in Thailand. Helicobacter pylori associated gastritis patients were randomized to 2 groups: group 1 (n=100) was tailored triple therapy with placebo (esomeprazole 20 mg bid, clarithromycin 500 mg bid or metronidazole 400 mg tid if clarithromycin resistance and amoxicillin 1000 mg bid), and group 2 was tailored triple therapy plus pretreatment with probiotic containing yogurt. Successful eradication was defined as both negative histology and negative rapid urease test at four weeks after treatment.
  
  
  RESULTS
  A total of 200 infected patients were enrolled. PP analysis involved 194 patients: 96 in the tailored triple therapy with placebo group (group 1) and 98 the in tailored triple therapy plus pretreatment with probiotic containing yogurt group (group 2). Successful eradication was observed in 170 (87.6%) patients; by PP analysis, the eradication rate was significantly higher in group 2 (P=0.04, 95%CI; 0.02-0.13) than in group 1. ITT analysis also showed that the value was significantly higher in the tailored triple threapy plus pretreatment with probiotic containing yogurt group (group 2) (89/100; 89%) than in the tailored triple therapy with placebo group (group 1) (P=0.01, 95%CI; 0.04-0.15). In terms of adverse events, there was no significant difference between the two groups.
  
  
  CONCLUSIONS
  Pretreatment with probiotic containing yogurt can improve Helicobacter pylori eradication rates with tailored triple therapy. Adding probiotics does not reduce adverse effects of the medication.
authors.affiliation: Department of Surgery, Institute of Medicine, Suranaree University of Technology Nakhonrachasima, Thailand E-mail : taweesak.t@sut.ac.th.
authors.forename: Taweesak
authors.initials: T
authors.lastname: Tongtawee
authors.forename: Chavaboon
authors.initials: C
authors.lastname: Dechsukhum
authors.forename: Wilairat
authors.initials: W
authors.lastname: Leeanansaksiri
authors.forename: Soraya
authors.initials: S
authors.lastname: Kaewpitoon
authors.forename: Natthawut
authors.initials: N
authors.lastname: Kaewpitoon
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Loyd
authors.forename: Likit
authors.initials: L
authors.lastname: Matrakool
authors.forename: Sukij
authors.initials: S
authors.lastname: Panpimanmas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000188:drug therapy* / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D048668:Lactobacillus delbrueckii; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D019936:Probiotics / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D013291:Streptococcus; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D064098:Esomeprazole