Evidence in treating Helicobacter pylori using probiotics

Review Article – Evidence in treating Helicobacter pylori using probiotics

Author – Spectrumceuticals Education, Research and Development

©Spectrumceuticals 2017 – This article, or parts thereof, may not be reproduced in any form without permission, except in the case of brief quotations embodied in critical articles and reviews.


This brief review summarises the available published primary and metadata studies on the effectiveness of probiotics inclusive of multiple strains formulations, single strains and probiotic yeast such as Saccharomyces boulardii in the treatment of Helicobacter pylori.

The standard treatment for H. pylori involves a two-week course of triple therapy (usually clarithromycin, amoxicillin and an acid suppressor such as lansoprazole or omeprazole), which also has gastrointestinal side effects. The summarised studies below outline a combination of probiotics used concurrently or post triple therapy and in place of triple therapy where eradication had failed.

Helicobacter pylori infection, with a prevalence in developing countries between 25–50% 1, induces chronic gastritis and, over time, may result in severe consequences ranging from peptic ulcers, gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue lymphoma.2 Early eradication of H. pylori prevents these consequences and is the best strategy to reduce the risk of gastric cancer.3

A 2007 meta-analysis on the effects of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy showed that supplementation with probiotics could be effective in increasing eradication rates during anti-H. pylori therapy regimes, and could be considered helpful for patients with eradication failure. Furthermore, probiotics showed a positive impact on H. pylori therapy-related side effects.4

A 2015 systematic review and meta-analysis into the eradication of Helicobacter pylori with probiotics showed: ‘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.’5,6

L. rhamnosus strain GG and Bifidobacterium breve

A probiotic supplement containing Lactobacillus rhamnosus strain GG and Bifidobacterium breve bacteria increased the Helicobacter pylori eradication rate in a placebo-controlled, double-blind randomised pilot study.6 In another study, the use of L. rhamnosus GG was shown to have a beneficial effect in decreasing the incidence of diarrhoea during anti-H. pylori therapy as well as a lower incidence of taste disturbance compared to placebo.7

Lactobacillus gasseri

A study which used Lactobacillus gasseri showed there was a decrease in the amount of H. pylori in the antral biopsies of patients.8

Lactobacillus reuteri

An in vivo study showed a significant decrease of H. pylori stomach colonisation after Lactobacillus reuteri supplementation in asymptomatic subjects with detectable H. pylori infection.9 Another study showed that L. reuteri possesses a cell surface protein that inhibits the binding of H. pylori to receptor glycolipids in vitro.10 Lactobacillus reuteri was shown to bind with Helicobacter pylori in another pilot study.11

Saccharomyces boulardii 

Lynne McFarland from the School of Pharmacy at the University of Washington in Seattle has conducted an extensive and thorough review of the research literature on Saccharomyces boulardii. Her review article ‘Systematic review and meta-analysis of Saccharomyces Boulardii in adults patients’ was published in the World Journal of Gastroenterology in May 2010.12 In a section of this article, titled ‘H. pylori’, she makes the following assessments of the available scientific literature regarding the efficacy of H. pylori:

  • S. boulardii induces morphologic changes in H. pylori consistent with cellular damage.
  • In one trial there was a 12% reduction in H. pylori colonisation in infected children.
  • In a study of 124 patients who received the triple therapy and S. boulardii there was an eradication rate of 71% in the S. boulardii group versus 60% in the placebo group. There was also a significant decrease in epigastric distress in the S. boulardii group (14%) versus 43.5% in the placebo group, as well as lower global dyspepsia symptom scores.
  • There was significant reduction in the frequency of antibiotic-associated diarrhoea (ADD).

These studies indicate that S. boulardii may not be effective in eradicating H. pylori itself, but it is effective in reducing the side effects of standard triple therapy.12

References

  1. Papamichael K, Mantzaris GJ. Pathogenesis of Helicobacter pylori infection: Colonization, virulence factors of the bacterium and immune and non-immune host response. Nosokom Chron. 2012; 7:32–37.
  2. Malfertheiner P, Link A, Selgrad M. Helicobacter pylori: Perspectives and time trends. Nat Rev Gastroenterol Hepatol. 2014 Oct; 11(10):628–38.
  3. Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2014 May 20; 348:g3174.
  4. Tong JL, Ran ZH, Shen J, Zhang CX and Xiao SD. Meta-analysis: The effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther. 2007; 25:155–168.
  5. Zhang MM, Qian W, Qin YY, He J and Zhou YH. Probiotics in Helicobacter pylori eradication therapy: A systematic review and meta-analysis. World J Gastroenterol. 2015 April 14; 21(14): 4345–57.
  6. Myllyluoma E, Veijola L, Ahlross T, Tynkkynen S, Kankuri E, Vapaatalo H, Rautelin H, Korpela R. Probiotic supplementation improves tolerance to Helicobacter pylori eradication therapy: A placebo-controlled, double-blind randomized pilot study. Aliment Pharmacol Ther. 2005; 21(10):1263–72.
  7. Cremonini F, Di Caro S, Covino M, Armuzzi A, Gabrielli M, Santarelli L, Nista EC, Cammarota G, Gasbarrini G, Gasbarrini A. Effect of different probiotic preparations on anti-Helicobacter pylori therapy-related side effects: A parallel group, triple blind, placebo-controlled study. Am J Gastroenterol: 2002: 97(11): 2744–9.
  8. Sakamoto I et al. Suppressive effect of Lactobacillus gasseri OLL 2716 (LG21) on Helicobacter pylori infection in humans, J Antimicrobial Chemother. 2001; 47(5):709–10.
  9. Mehling H and Busjahn A. Non-viable Lactobacillus reuteri DSMZ 17648 (Pylopass™) as a new approach to Helicobacter pylori control in humans. Nutrients. 2013; 5(8):3062–73.
  10. Mukai T, Asasaka T., Sato E., Mori K., Matsumoto M., Ohori H. Inhibition of binding of Helicobacter pylori to the glycolipid receptors by probiotic Lactobacillus reuteri. FEMS Immunol Med Microbiol. 2002: 32(2):105–10.
  11. Holz C, Busjahn A, Mehling H, Arya S, Boettner M, Habibi H, Lang C. Significant reduction in Helicobacter pylori load in humans with non-viable Lactobacillus reuteri DSM17648: A pilot study. Probiotics Antomicrob Proteins. 2015: 7(2):91–100.
  12. McFarland LV, Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010 May 14; 16(18): 2202–22. Published online 2010 May 14. doi: 10.3748/wjg.v16.i18.2202 PMCID: PMC2868213

 

©Spectrumceuticals 2017 – This article, or parts thereof, may not be reproduced in any form without permission, except in the case of brief quotations embodied in critical articles and reviews.