Lau Christine S M, Ward Amanda, Chamberlain Ronald S
Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies.
Saint George's University School of Medicine, Grenada, West Indies.
Infect Drug Resist. 2016 Dec 7;9:275-289. doi: 10.2147/IDR.S117886. eCollection 2016.
colonization is present in half of the world's population and can lead to numerous gastrointestinal diseases if left untreated, including peptic ulcer disease and gastric cancer. Although concurrent triple therapy remains the recommended treatment regimen for eradication, its success rate and efficacy have been declining. Recent studies have shown that the addition of probiotics can significantly increase eradication rates by up to 50%. This meta-analysis examines the impact of probiotic supplementation on the efficacy of standard triple therapy in eradicating .
A comprehensive literature search was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (time of inception to 2016) to identify all published randomized control trials (RCTs) assessing the use of probiotics in addition to triple therapy for the treatment of . Searches were conducted using the keywords "probiotics", "triple therapy", and "". RCTs comparing the use of probiotics and standard triple therapy with standard triple therapy alone for any duration in patients of any age diagnosed with infection were included. eradication rates (detected using urea breath test or stool antigen) were analyzed as-per-protocol (APP) and intention-to-treat (ITT).
A total of 30 RCTs involving 4,302 patients APP and 4,515 patients ITT were analyzed. The addition of probiotics significantly increased eradication rates by 12.2% (relative risk [RR] =1.122; 95% confidence interval [CI], 1.091-1.153; <0.001) APP and 14.1% (RR =1.141; 95% CI, 1.106-1.175; <0.001) ITT. Probiotics were beneficial among children and adults, as well as Asians and non-Asians. No significant difference was observed in efficacy between the various types of probiotics. The risk of diarrhea, nausea, vomiting, and epigastric pain was also reduced.
The addition of probiotics is associated with improved eradication rates in both children and adults, as well as Asians and non-Asians. , , , and mixtures of probiotics appear beneficial in eradication. Furthermore, the reduction in antibiotic-associated side effects such as nausea, vomiting, diarrhea, and epigastric pain improves medication tolerance and patient compliance. Given the consequences associated with chronic infection, the addition of probiotics to the concurrent triple therapy regimen should be considered in all patients with infection. However, further studies are required to identify the optimal probiotic species and dose.
幽门螺杆菌定植存在于全球半数人口中，若不治疗可导致多种胃肠道疾病，包括消化性溃疡病和胃癌。尽管联合三联疗法仍是推荐的根除治疗方案，但其成功率和疗效一直在下降。最近的研究表明，添加益生菌可使根除率显著提高多达50%。本荟萃分析探讨了补充益生菌对标准三联疗法根除幽门螺杆菌疗效的影响。
使用PubMed、Cochrane对照试验中央注册库和谷歌学术（起始时间至2016年）进行全面的文献检索，以识别所有已发表的随机对照试验（RCT），这些试验评估了除三联疗法外使用益生菌治疗幽门螺杆菌感染的情况。检索使用关键词“益生菌”“三联疗法”和“幽门螺杆菌感染”。纳入了比较在任何年龄诊断为幽门螺杆菌感染的患者中，使用益生菌联合标准三联疗法与单独使用标准三联疗法在任何疗程中的RCT。按照方案分析（APP）和意向性分析（ITT）分析幽门螺杆菌根除率（使用尿素呼气试验或粪便抗原检测）。
共分析了30项RCT，涉及4302例按方案分析患者和4515例意向性分析患者。添加益生菌使按方案分析的根除率显著提高12.2%（相对危险度[RR]=1.122；95%置信区间[CI]，1.091 - 1.153；P<0.001），意向性分析的根除率提高14.1%（RR =1.141；95%CI，1.106 - 1.175；P<0.001）。益生菌在儿童和成人以及亚洲人和非亚洲人中均有益。不同类型的益生菌在疗效上未观察到显著差异。腹泻、恶心、呕吐和上腹部疼痛的风险也降低了。
添加益生菌与提高儿童和成人以及亚洲人和非亚洲人的幽门螺杆菌根除率相关。单一菌株、多种菌株、不同组合的益生菌在根除幽门螺杆菌方面似乎都有益。此外，抗生素相关副作用如恶心、呕吐、腹泻和上腹部疼痛的减少提高了药物耐受性和患者依从性。鉴于慢性幽门螺杆菌感染的后果，所有幽门螺杆菌感染患者在联合三联疗法方案中都应考虑添加益生菌。然而，需要进一步研究以确定最佳的益生菌种类和剂量。
