Boltin Doron
Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Best Pract Res Clin Gastroenterol. 2016 Feb;30(1):99-109. doi: 10.1016/j.bpg.2015.12.003. Epub 2015 Dec 18.
The ideal treatment regimen for the eradication Helicobacter pylori infection has yet to be identified. Probiotics, particularly Lactobacillus, Bifidobacterium and Saccharomyces, have been suggested as adjuncts to antibiotics for the treatment of H. pylori. There is in vitro evidence that probiotics dampen the Th1 response triggered by H. pylori, attenuate H. pylori associated hypochlorhydria and secrete bacteriocidal metabolites. Probiotics interact with the innate host immune system through adherence to the gastric epithelium and secretion of bacterial adhesins. In prospective human studies, probiotic monotherapy effectively decrease H. pylori density (expired (13)CO2) by 2.0%-64.0%. Probiotic monotherapy has also been shown to eradicate H. pylori in up to 32.5%, although subsequent recrudescence is likely. Eleven meta-analyses have evaluated the efficacy of probiotics as adjuvants to antibiotics for the eradication of H. pylori. The addition of a probiotic increased treatment efficacy, OR 1.12-2.07. This benefit is probably strain-specific and may only be significant with relatively ineffective antibiotic regimens. The pooled prevalence of adverse effects was 12.9%-31.5% among subjects receiving adjuvant probiotics, compared with 24.3%-45.9% among controls. Diarrhea in particular was significantly reduced in subjects receiving adjuvant probiotics, compared with controls (OR 0.16-0.47). A reduction in adverse events other than diarrhea is variable. Despite the apparent benefit on efficacy and side effects conferred by probiotics, the optimal probiotic species, dose and treatment duration has yet to be determined. Further studies are needed to identify the probiotic, antibiotic and patient factors which might predict benefit from probiotic supplementation.
根除幽门螺杆菌感染的理想治疗方案尚未确定。益生菌，特别是乳酸杆菌、双歧杆菌和酵母菌，已被建议作为抗生素治疗幽门螺杆菌的辅助药物。体外证据表明，益生菌可抑制幽门螺杆菌引发的Th1反应，减轻幽门螺杆菌相关的胃酸过少，并分泌杀菌代谢产物。益生菌通过粘附于胃上皮细胞和分泌细菌粘附素来与宿主固有免疫系统相互作用。在前瞻性人体研究中，益生菌单一疗法可有效降低幽门螺杆菌密度（呼出的(13)CO2）2.0%-64.0%。益生菌单一疗法也已显示在高达32.5%的患者中根除幽门螺杆菌，尽管随后可能会复发。11项荟萃分析评估了益生菌作为抗生素辅助药物根除幽门螺杆菌的疗效。添加益生菌可提高治疗效果，比值比为1.12-2.07。这种益处可能具有菌株特异性，并且可能仅在相对无效的抗生素治疗方案中才显著。接受辅助益生菌治疗的受试者中不良反应的合并发生率为12.9%-31.5%，而对照组为24.3%-45.9%。与对照组相比，接受辅助益生菌治疗的受试者腹泻尤其显著减少（比值比为0.16-0.47）。腹泻以外的不良事件减少情况各不相同。尽管益生菌在疗效和副作用方面有明显益处，但最佳的益生菌种类、剂量和治疗持续时间尚未确定。需要进一步研究以确定可能从补充益生菌中获益的益生菌、抗生素和患者因素。
