A meta-analysis of randomized controlled trials of bismuth-containing quadruple therapy combined with probiotic supplement for eradication of Helicobacter pylori

Abstract

Objective: The bismuth containing quadruple therapy (BCQT) acts as first-line therapy in China. Probiotics supplement also shows Helicobacter pylori eradication effects. Adding probiotics along with BCQT may improve eradication rate of Helicobacter pylori. Methods: Electronic databases including Medline, Embase, Wanfang Database, etc. were searched by the established searching strategy. After that, a funnel plot was adopted to evaluate publication bias. The meta-analysis was supplemented in fixed effect model for low heterogeneity and randomized effect model for high heterogeneity conversely. Results: A total of 16 RCTs with 2 466 subjects finally met the inclusion criteria. There was no significant heterogeneity among the trials. Compared with control group (BCQT only), the probiotic group (combined supplement of probiotics and BCQT) underwent higher eradication rate[90.76%(1 130/1 245) vs 80.43%(982/1 221)]with statistical significance (P=0.000). The probiotics might improve the eradication rate in patients not receiving previous eradication therapy [89.00%(445/500) vs 84.73%(416/491), P=0.04]. Probiotics might also improve the eradication rate[91.06%(326/358) vs 73.83%(268/363)]in patients relapsed from triple therapy (P=0.000). The patients who underwent the combination of BCQT and single Lactobacillus genus showed higher eradiation rate than those with two or more genera. Moreover, fewer adverse reactions were reported in probiotics group than that in control group[13.59%(104/765) vs 28.90%(213/737), P=0.000]. Conclusions: The combination of BCQT and probiotics may improve the eradication rate of Helicobacter pylori especially in patients receiving front-line eradication regimen or failed from triple therapy. Probiotics may reduce the adverse reactions when combined with other eradication agents.