Cancer
Probiotics increase Helicobacter pylori eradication rate
Sheu B.S., et al
Townsend Letter for Doctors and Patients, Issue. 281, p 51 (01-12-2006)
One hundred thirty-eight patients with Helicobacter pylori infections that had been resistant to conventional triple therapy were randomly assigned to receive quadruple therapy alone (amoxicillin, metronidazole, omeprazole, and bismuth) for one week or quadruple therapy plus pretreatment with a lactobacillus- and bifidobacterium-containing yogurt (AB-yogurt). The yogurt was administered at a dose of 200 ml twice a day for four weeks prior to the start of quadruple therapy. The H. pylori eradication rate (evaluated at least six weeks after quadruple therapy) was higher in the yogurt group than in the quadruple therapy-only group (intent-to-treat analysis, 85% vs. 71.1%; p < 0.05; per-protocol analysis, 90.8% vs. 76.6%; p < 0.05).
Comment: Previous studies have shown that concurrent administration of probiotics can enhance the efficacy of triple therapy, in part by reducing the adverse effects of the antibiotic regimen and increasing compliance with the treatment. In the present study, the increase in eradication rate cannot be explained by greater compliance with quadruple therapy, because probiotic supplementation also increased the eradication rate in the intent-to-treat analysis, which includes patients who did not complete quadruple therapy. Pretreatment with AB yogurt probably worked by decreasing the H. pylori load, thereby improving the efficacy of subsequent quadruple therapy.
Sheu B.S., et al. Pretreatment with Lactobacillus- and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy. Am J Clin Nutr. 2006;83:864-869.
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Treatment of H. pylori Infection: A Review
Candelli M., Nista E.C., Carloni E., Pignataro G., Zocco M.A., Cazzato A., Di Campli C., Fini L., Gasbarrini G., Gasbarrini A..
Helicobacter pylori infection has been indicated as the main pathogenic factor in the development of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although the vast majority of infected subjects do not carry but a mild, asymptomatic gastritis, still there are some cases in which the eradication of the infection appears mandatory. This review addresses current anti-Helicobacter regimens and pharmacological resources, and highlights the pros and cons of each of them, according to the most recent and reliable clinical trials. Also, basic recommendations are given, regarding treatment choice in the event of the failure of a first or second line eradicating strategy, and about the implementation of standard regimens with newer antibacterial devices as probiotics.
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Effect of Lactobacillus casei supplementation on the effectiveness and tolerability of a new second-line 10-day quadruple therapy after failure of a first attempt to cure Helicobacter pylori infection
Tursi A., Brandimarte G., Giorgetti GM., Modeo M.E.
Digestive Endoscopy Unit, "Lorenzo Bonomo" Hospital, Andria (BA), Italy.
Background: Probiotics have never been used as second-line treatment in patients resistant to a first course of anti-H. pylori treatment.
Material/Methods:
70 consecutive patients with persistent H. pylori infection were enrolled and treated with ranitidine bismuth citrate (RBC) 400 mg b.d, esomeprazole or pantoprazole 40 mg/day, amoxycillin 1 g t.d, tinidazole 500 mg b.d. with (group A) or without (group B) supplementation with 750 mg daily containing 16 billion bacteria Lactobacillus casei subsp. casei DG. Esomeprazole or pantoprazole 40 mg/day was administered for a further 4 weeks in cases of active peptic ulcer or severe gastritis detected at endoscopy. In these cases endoscopy was repeated one month after conclusion of therapy. The remaining patients were checked by alC-urea breath test.
Results: Sixty-six patients completed the study, 34 in group A and 32 in group B. One group A patient (2.85%) was excluded for protocol violation and one group B patient (2.85%) was lost to follow-up. 33/34 group A patients were H. pylori-negative [per-protocol: 97.05%, on intention-to-treat: 94.28%]. 5/34 patients (14.7%) showed side-effects, but all of them completed the treatment. In group B, two patients (5.71%) showed severe side-effects and were withdrawn from the study. 30/32 patients were H. pylori- negative [per-protocol: 93.75%, on intention-to-treat: 85.71% (p=n.s.)]. 11/32 patients (34.37%) showed side-effects, but all of them completed the study (p < 0.05).
Conclusions: This 10-day quadruple therapy obtains a high eradication rate, but probiotic supplementation reduces side-effects and permits a slight improvement in eradicating H. pylori.
Med Sci Monit. 2004 Nov 24;10(12):CR662-666
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