Wu You, Dong Xiao Yang, Zhou Xian Zhu, Li Zhao Shen, Du Yi Qi
Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China.
J Dig Dis. 2022 Aug;23(8-9):462-472. doi: 10.1111/1751-2980.13138.
This study aimed to assess the efficacy and safety of probiotics for Helicobacter pylori (H. pylori) eradication therapy as well as their effects on gastric microbiota.
Patients who had failed H. pylori eradication therapy for at least twice were prospectively enrolled during March 2019 and March 2021. A 2-week administration of compound Lactobacillus acidophilus probiotic (1 g thrice daily) followed by a 10-day quadruple bismuth-containing H. pylori eradication therapy was administrated. Endoscopy was performed, and gastric biopsy samples were obtained for drug sensitivity testing and 16S rRNA gene sequencing before and after probiotic treatment. Eradication was evaluated by the C-urea breath test at least 4 weeks after treatment completion. Adverse events (AEs) were recorded.
Thirty-seven patients were included. Probiotic supplementation had no effects on the diversity, community structure, and composition of gastric microbiota and no inhibition on H. pylori activity. However, it increased some of the beneficial bacteria such as Blautia, Dorea, and Roseburia (P < 0.05). The overall eradication rate was 97.3% (95% confidence interval [CI] 91.8%-100%). AEs, mainly dizziness, nausea, diarrhea, and chest distress, were detected in six individuals, all of which were resolved upon cessation of antibiotic administration. Dyspeptic symptoms were improved after probiotic supplementation and at treatment completion (both P < 0.001).
H. pylori-infected individuals might benefit from probiotics followed by a quadruple bismuth-containing eradication therapy. Further studies with large sample sizes are warranted.
本研究旨在评估益生菌在幽门螺杆菌（H. pylori）根除治疗中的疗效和安全性，以及它们对胃微生物群的影响。
前瞻性纳入2019年3月至2021年3月期间至少两次幽门螺杆菌根除治疗失败的患者。先给予2周的复方嗜酸乳杆菌益生菌（每日3次，每次1g），随后进行为期10天的含铋四联幽门螺杆菌根除治疗。进行内镜检查，并在益生菌治疗前后获取胃活检样本进行药敏试验和16S rRNA基因测序。治疗完成至少4周后通过C-尿素呼气试验评估根除情况。记录不良事件（AE）。
纳入37例患者。补充益生菌对胃微生物群的多样性、群落结构和组成没有影响，对幽门螺杆菌活性也没有抑制作用。然而，它增加了一些有益菌，如布劳特氏菌属、多雷亚菌属和罗斯氏菌属（P < 0.05）。总体根除率为97.3%（95%置信区间[CI] 91.8%-100%）。6例患者检测到AE，主要为头晕、恶心、腹泻和胸闷，在停用抗生素后均得到缓解。补充益生菌后和治疗完成时消化不良症状均得到改善（均P < 0.001）。
幽门螺杆菌感染个体可能从益生菌联合含铋四联根除治疗中获益。有必要进行更大样本量的进一步研究。
