Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis.

Abstract

Whether Saccharomyces boulardii (Sboulardii) as an adjuvant therapy are beneficial to Hpylori eradication remains controversial. The aim of the study was to update and determine the effects of Sboulardii as an adjuvant therapy on Hpylori eradication rates and adverse effects. We searched PubMed, Embase, CENTRAL, and Web of Science to collect all randomized controlled trials assessing the effects of Sboulardii as an adjuvant therapy for Hpylori eradication from inception to February 2019. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis was performed to control the risk of type I and type II errors. Eighteen trials with 3592 patients were eligible for meta-analysis. Compared with standard eradication regimen, the Sboulardii supplementation could significantly improve eradication rates [risk ratio (RR)=1.09, 95% confidence interval (CI):1.05-1.13; moderate quality evidence] and reduce the incidence of total side effects (RR=0.47, 95%CI:0.36-0.61; low quality evidence), as well as some gastrointestinal adverse effects, especially diarrhea (RR=0.33, 95%CI:0.23-0.47; low quality evidence) and constipation (RR=0.37, 95%CI:0.23-0.57; moderate quality evidence). In addition, the need for discontinuation rate in Sboulardii supplementation group was significantly lower than in the control group (RR=0.33, 95%CI:0.16-0.69, P=.003; moderate quality evidence). The TSA results for overall eradication rates and total side effects indicated that the effects were conclusive. Our meta-analysis shows that Sboulardii supplementation on standard eradication therapy significantly increased Hpylori eradication rates and reduced the incidence of total side effects and some gastrointestinal adverse effects during eradication therapy.