title: Probiotics improve the efficacy of standard triple therapy in the eradication ofHelicobacter pylori: a meta-analysis.
abstract: BACKGROUND
  Helicobacter pyloricolonization is present in half of the world's population and can lead to numerous gastrointestinal diseases if left untreated, including peptic ulcer disease and gastric cancer. Although concurrent triple therapy remains the recommended treatment regimen forH. pylorieradication, its success rate and efficacy have been declining. Recent studies have shown that the addition of probiotics can significantly increase eradication rates by up to 50%. This meta-analysis examines the impact of probiotic supplementation on the efficacy of standard triple therapy in eradicatingH. pylori.
  
  
  METHODS
  A comprehensive literature search was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (time of inception to 2016) to identify all published randomized control trials (RCTs) assessing the use of probiotics in addition to triple therapy for the treatment ofH. pylori. Searches were conducted using the keywords "probiotics", "triple therapy", and "Helicobacter pylori". RCTs comparing the use of probiotics and standard triple therapy with standard triple therapy alone for any duration in patients of any age diagnosed withH. pyloriinfection were included.H. pylorieradication rates (detected using urea breath test or stool antigen) were analyzed as-per-protocol (APP) and intention-to-treat (ITT).
  
  
  RESULTS
  A total of 30 RCTs involving 4,302 patients APP and 4,515 patients ITT were analyzed. The addition of probiotics significantly increased eradication rates by 12.2% (relative risk [RR] =1.122; 95% confidence interval [CI], 1.091-1.153;P<0.001) APP and 14.1% (RR =1.141; 95% CI, 1.106-1.175;P<0.001) ITT. Probiotics were beneficial among children and adults, as well as Asians and non-Asians. No significant difference was observed in efficacy between the various types of probiotics. The risk of diarrhea, nausea, vomiting, and epigastric pain was also reduced.
  
  
  CONCLUSIONS
  The addition of probiotics is associated with improvedH. pylorieradication rates in both children and adults, as well as Asians and non-Asians.Lactobacillus,Bifidobacterium,Saccharomyces, and mixtures of probiotics appear beneficial inH. pylorieradication. Furthermore, the reduction in antibiotic-associated side effects such as nausea, vomiting, diarrhea, and epigastric pain improves medication tolerance and patient compliance. Given the consequences associated with chronicH. pyloriinfection, the addition of probiotics to the concurrent triple therapy regimen should be considered in all patients withH. pyloriinfection. However, further studies are required to identify the optimal probiotic species and dose.
authors.affiliation: Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies.
authors.forename: Christine S M
authors.initials: CS
authors.lastname: Lau
authors.affiliation: Saint George's University School of Medicine, Grenada, West Indies.
authors.forename: Amanda
authors.initials: A
authors.lastname: Ward
authors.affiliation: Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies; Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA; Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Chamberlain
keywords: Helicobacter pylori; meta-analysis; probiotics; triple therapy