title: Use of probiotics as an adjuvant to sequential H. pylori eradication therapy: impact on eradication rates, treatment resistance, treatment-related side effects, and patient compliance.
abstract: OBJECTIVE
  To evaluate the effect of probiotics administered as an adjuvant to sequential Helicobacter pylori (H. pylori) eradication therapy on treatment outcome and patient compliance.
  
  
  METHODS
  In total, 159 patients with H. pylori infection receiving sequential H. pylori eradication therapy were included in this randomized placebo-controlled study. Starting from day 0 of sequential eradication therapy (ERA), patients in the ERA+probiotic group [n=53, mean (SD) age: 47.7 (14.0) years, 54.7% were females] also received a probiotic supplement with Bifidobacterium animalis subsp. lactis B94 (1 capsule/day), patients in the ERA+placebo group [n=52, mean (SD) age: 46.4 (13.4) years, 51.9% were males] received placebo treatment (1 capsule/day), and patients in the ERA-only group [n=54, mean (SD) age: 46.3 (11.9) years, 55.6% were females] received no additional treatments. Eradication rates, patient compliance, and side effects of eradication therapy were recorded in each treatment group.
  
  
  RESULTS
  Significantly higher eradication rates were noted in the ERA+probiotic group (86.8% vs. 70.8%, p=0.025) than in the combined ERA (ERA-only and ERA-placebo) group. Non-compliance with anti-H. pylori treatment was noted in 24 (15.1%) of 159 patients. Lower rates of first week treatment non-compliance due to diarrhea (1.88% vs. 12.26%, p=0.036) were noted in the ERA+probiotic group than in the combined ERA (ERA-only and ERA-placebo) group. Treatment resistance (p: 0.389) was similar between the groups, indicating pure antibiotic resistance without any compliance problems. The number needed to treat for an additional beneficial outcome (NNTB) was 6.2 (CI 95%, 3.5 to 28.9) for probiotic use.
  
  
  CONCLUSIONS
  In conclusion, adjuvant administration of probiotic (B. animalis subsp. lactis) in 2-week sequential H. pylori eradication therapy is associated with a higher H. pylori eradication rate, lower first week diarrhea-related treatment discontinuation rates, less common self-reported side effects, and higher treatment compliance.
authors.affiliation: Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey. ayhancekin@hotmail.com.
authors.forename: Ayhan Hilmi
authors.initials: AH
authors.lastname: Çekin
authors.forename: Yasin
authors.initials: Y
authors.lastname: Şahintürk
authors.forename: Ferda
authors.initials: F
authors.lastname: Akbay Harmandar
authors.forename: Seyit
authors.initials: S
authors.lastname: Uyar
authors.forename: Başak Oğuz
authors.initials: BO
authors.lastname: Yolcular
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Çekin
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000855:Anorexia / Q000139:chemically induced; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069982:Bifidobacterium animalis; D017291:Clarithromycin / Q000627:therapeutic use; D003967:Diarrhea / Q000139:chemically induced; D004244:Dizziness / Q000139:chemically induced; D003875:Drug Eruptions / Q000209:etiology; D004351:Drug Resistance / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006261:Headache / Q000139:chemically induced; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D061366:Numbers Needed To Treat; D000077402:Pantoprazole; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D063189:Symptom Assessment; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D000077402:Pantoprazole; D017291:Clarithromycin