Lactobacillus GG Supplementation on Anti-Helicobacter pylori Therapy-Related Side Effects and Eradication Rates: A Meta-Analysis

Shristi Shakya, Guoqiang Zhang, Huajian Hu, Zhongyue Li^*

Department of Gastroenterology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China.

DOI: 10.4236/ojim.2015.54014                

Abstract

Background: Concerns still exist with respect to unsatisfactory eradication rates and/or therapy-associated side effects for the use of standard triple therapy in the treatment of Helicobacter pylori infection, which prompts considerable interest in new therapy. We systematically reviewed the literature to investigate whether Lactobacillus GG as supplementation to standard triple therapy could improve H. pylori eradication rates and/or reduce therapy-associated side effects. Methods: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched from their inception to August 4, 2015 for randomized controlled trials (RCTs). The language was restricted to English only. Results: Four RCTs involving a total of 305 participants (including 83 children) were included. Lactobacillus GG given along with triple therapy significantly reduced the risk of overall H. pylori therapy-related adverse effects (three RCTs, n = 221, RR 0.59, 95% CI 0.45 - 0.78), particularly of diarrhea (four RCTs, n = 285, RR 0.23, 95% CI 0.11 - 0.47), bloating (four RCTs, n = 289, RR 0.61, 95% CI 0.41 - 0.90), and taste disturbance (four RCTs, n = 288, RR 0.38, 95% CI 0.23 - 0.62). There were no significant differences between groups in the risk of other adverse effects. No beneficial effects of Lactobacillus GG were observed for H. pylori eradication rates (four RCTs, n = 284, RR 0.99, 95% CI 0.88 - 1.13). Conclusion: Current evidence indicates that Lactobacillus GG administered along with standard triple therapy is a feasible way to reduce therapy-related side effects, particularly diarrhea, bloating, and taste disturbance. However, Lactobacillus GG shows no effects on eradication rates.

Keywords

Lactobacillus GG, Helicobacter pylori, Side Effects, Eradication Rate, Meta-Analysis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Palli, D., Menegatti, M., Masala, G., et al. (2002) Helicobacter Pylori Infection, Anti-cagA Antibodies and Peptic Ulcer: A Case-Control Study in Italy. Alimentary Pharmacology & Therapeutics, 16, 1015-1020. http://dx.doi.org/10.1046/j.1365-2036.2002.01253.x
[2]	Graham, D.Y. (2015) Helicobacter pylori Update: Gastric Cancer, Reliable Therapy, and Possible Benefits. Gastroenterology, 148, 719-731.e3. http://dx.doi.org/10.1053/j.gastro.2015.01.040
[3]	Bayerdorffer, E. and Morgner, A. (2000) Gastric Marginal Zone B-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue Type: Management of the Disease. Digestive and Liver Disease, 32, 192-194. http://dx.doi.org/10.1016/S1590-8658(00)80819-1
[4]	Graham, D.Y. and Fischbach, L. (2010) Helicobacter pylori Treatment in the Era of Increasing Antibiotic Resistance. Gut, 59, 1143-1153. http://dx.doi.org/10.1136/gut.2009.192757
[5]	Tong, J.L., Ran, Z.H., Shen, J., Zhang, C.X. and Xiao, S.D. (2007) Meta-Analysis: The Effect of Supplementation with Probiotics on Eradication Rates and Adverse Events during Helicobacter pylori Eradication Therapy. Alimentary Pharmacology & Therapeutics, 25, 155-168. http://dx.doi.org/10.1111/j.1365-2036.2006.03179.x
[6]	Malfertheiner, P., Megraud, F., O’Morain, C.A., et al. (2012) Management of Helicobacter pylori Infection—The Maastricht IV/ Florence Consensus Report. Gut, 61, 646-664. http://dx.doi.org/10.1136/gutjnl-2012-302084
[7]	Dang, Y., Reinhardt, J.D., Zhou, X. and Zhang, G. (2014) The Effect of Probiotics Supplementation on Helicobacter pylori Eradication Rates and Side Effects during Eradication Therapy: A Meta-Analysis. PLoS One, 9, e111030. http://dx.doi.org/10.1371/journal.pone.0111030
[8]	Lionetti, E., Indrio, F., Pavone, L., Borrelli, G., Cavallo, L. and Francavilla, R. (2010) Role of Probiotics in Pediatric Patients with Helicobacter pylori Infection: A Comprehensive Review of the Literature. Helicobacter, 15, 79-87. http://dx.doi.org/10.1111/j.1523-5378.2009.00743.x
[9]	Liberati, A., Altman, D.G., Tetzlaff, J., et al. (2009) The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. Annals of Internal Medicine, 151, W65-W94. http://dx.doi.org/10.7326/0003-4819-151-4-200908180-00136
[10]	Higgins, J.P.T. and Green, S. (2006) Cochrane Handbook for Systematic Reviews of Interventions 4.2.6. In: The Cochrane Library, Issue 4, John Wiley & Sons Ltd., Chichester.
[11]	Higgins, J.P., Altman, D.G., Gotzsche, P.C., et al. (2011) The Cochrane Collaboration’s Tool for Assessing Risk of Bias in Randomised Trials. British Medical Journal, 343, Article ID: d5928. http://dx.doi.org/10.1136/bmj.d5928
[12]	Higgins, J.P., Thompson, S.G., Deeks, J.J. and Altman, D.G. (2003) Measuring Inconsistency in Meta-Analyses. British Medical Journal, 327, 557-560. http://dx.doi.org/10.1136/bmj.327.7414.557
[13]	Worona-Dibner, L.B. (2009) Randomized, Double-Blind, Placebo-Controlled Trial: Effect of Lactobacillus GG Supplementation on Helicobacter Pylori Eradication Rates and Side Effects during Treatment in Children. Revista de Gastroenterología de México, 74, 142-143.
[14]	Padilla Ruiz, M., Fernandez Aguiar, M.E., Arce Nunez, M. and Polo Amorin, R. (2013) Lactobacillus rhamnosus GG Supplementation to Reduce Side-Effects of Anti-Helicobacter Pylori Treatment. Revista de Gastroenterología del Perú, 33, 121-130.
[15]	Armuzzi, A., Cremonini, F., Ojetti, V., et al. (2001) Effect of Lactobacillus GG Supplementation on Antibiotic-Associated Gastrointestinal Side Effects during Helicobacter pylori Eradication Therapy: A Pilot Study. Digestion, 63, 1-7. http://dx.doi.org/10.1159/000051865
[16]	Armuzzi, A., Cremonini, F., Bartolozzi, F., et al. (2001) The Effect of Oral Administration of Lactobacillus GG on Antibiotic-Associated Gastrointestinal Side-Effects during Helicobacter pylori Eradication Therapy. Alimentary Pharmacology & Therapeutics, 15, 163-169. http://dx.doi.org/10.1046/j.1365-2036.2001.00923.x
[17]	Cremonini, F., Di Caro, S., Covino, M., et al. (2002) Effect of Different Probiotic Preparations on Anti-Helicobacter Pylori Therapy-Related Side Effects: A Parallel Group, Triple Blind, Placebo-Controlled Study. American Journal of Gastroenterology, 97, 2744-2749. http://dx.doi.org/10.1111/j.1572-0241.2002.07063.x
[18]	Szajewska, H., Albrecht, P. and Topczewska-Cabanek, A. (2009) Randomized, Double-Blind, Placebo-Controlled Trial: Effect of Lactobacillus GG Supplementation on Helicobacter pylori Eradication Rates and Side Effects during Treatment in Children. Journal of Pediatric Gastroenterology and Nutrition, 48, 431-436. http://dx.doi.org/10.1097/MPG.0b013e318182e716
[19]	Higgins, J.P.T. and Green, S., Eds. (2005) Cochrane Handbook for Systematic Reviews of Interventions 4.2.4. John Wiley & Sons Ltd, Chichester.
[20]	Higgins, J.P.T. and Green, S., Eds. (2008) Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration. http://www.cochrane-handbook.org
[21]	McFarland, L.V. (2006) Meta-Analysis of Probiotics for the Prevention of Antibiotic Associated Diarrhea and the Treatment of Clostridium difficile Disease. American Journal of Gastroenterology, 101, 812-822. http://dx.doi.org/10.1111/j.1572-0241.2006.00465.x
[22]	Szajewska, H., Ruszczynski, M. and Radzikowski, A. (2006) Probiotics in the Prevention of Antibiotic-Associated Diarrhea in Children: A Meta-Analysis of Randomized Controlled Trials. Journal of Pediatrics, 149, 367-372. http://dx.doi.org/10.1016/j.jpeds.2006.04.053
[23]	Wang, Z.H., Gao, Q.Y. and Fang, J.Y. (2013) Meta-Analysis of the Efficacy and Safety of Lactobacillus-Containing and Bifidobacterium-Containing Probiotic Compound Preparation in Helicobacter pylori Eradication Therapy. Journal of Clinical Gastroenterology, 47, 25-32. http://dx.doi.org/10.1097/MCG.0b013e318266f6cf
[24]	Myllyluoma, E., Ahonen, A.M., Korpela, R., Vapaatalo, H. and Kankuri, E. (2008) Effects of Multispecies Probiotic Combination on Helicobacter pylori Infection in Vitro. Clinical and Vaccine Immunology, 15, 1472-1482. http://dx.doi.org/10.1128/CVI.00080-08
[25]	Szajewska, H., Horvath, A. and Piwowarczyk, A. (2010) Meta-Analysis: The Effects of Saccharomyces boulardii Supplementation on Helicobacter pylori Eradication Rates and Side Effects during Treatment. Alimentary Pharmacology & Therapeutics, 32, 1069-1079. http://dx.doi.org/10.1111/j.1365-2036.2010.04457.x