Probiotics in the complex of Helicopter pylori eradication therapy: effectiveness, possibilities of complications prevention

Objective — to assess the efficacy and safety of complex eradication therapy of Helicobacter рylori using Saccharomyces boulardii (Esbulardi), with an assessment of the impact of treatment on the intestinal microbiome and the role of probiotics in the dysbiosis prevention. Materials and methods. We conducted a multicenter, prospective, randomized, controlled, comparative study in parallel groups. Under our observation were 78 patients with chronic gastritis associated with H. pylori infection, with the presence of erosions of the gastric mucosa, who had no previous episodes of eradication of helicobacter infection. Among the examined were 40 men and 38 women aged 26 to 53 years, and 30 practically healthy individuals of the same age who were the control group. To analyze the presence of Helicobacter pylori, all patients underwent a 13С­urease breath test. In addition, all patients before and after therapy were assessed for changes in the intestinal microbiome according to the hydrogen breath test to analyze the presence of bacterial overgrowth syndrome (SIBO). Before inclusion in the study, all patients underwent fibrogastroduodenoscopy. During endoscopy, a gastric mucosal biopsy (GM) was performed to confirm the diagnosis of chronic gastritis. Of the 78 screened patients, 62 patients were randomized and divided into 2 groups. 30 patients received quadruple therapy for the eradication of H. pylori, which included amoxicillin, clarithromycin for 14 days, PPIs and bismuth preparations, in a dosage that meets the Maastricht VI recommendations. In addition, patients received the probiotic Esbulardi (Saccharomyces boulardii) from the company Bichels (Ukraine). 32 patients received only standard eradication therapy and were the comparison group. Results. Before treatment, the clinical, endoscopic and morphological picture of chronic gastritis (CG) in patients of both groups did not differ. In patients with H. pylori‑associated CG with erosions of the gastric mucosa, complaints of epigastric pain and manifestations of organic dyspepsia dominated before treatment, which characterized postprandial distress syndrome in the presence of single erosions in the antrum of the stomach with an increase in proinflammatory cells in the gastric mucosa, glandular atrophy and focal metaplasia. The use of Esbulardi in the complex of H. pylori eradication therapy allowed for improved tolerability of the treatment course and its increased effectiveness. While in the group of patients who took Esbulardi, all patients completed the treatment, in the comparison group, only 28 (87.5%) patients completed the therapeutic course. The effectiveness of treatment in the main group of patients was 86.7%, in the comparison group — 78.2% (p<0.05). The use of Esbulardi significantly affected the symptoms of organic dyspepsia in patients with H. pylori‑associated CG, the minimization of which significantly affects the tolerability of the eradication course and improves the clinical picture of the disease. In the group of patients who took Esbulardi, the frequency of SIBO significantly decreased compared to patients before treatment (30.0% and 58.0%, respectively, p<0.05). At the same time, among patients receiving standard eradication therapy, the frequency of SIBO increased and exceeded the indicators not only of the main group, but also of patients before therapy (59.4%). Conclusions. The use of Esbulardi in the complex therapy of patients with H. pylori‑associated CG with the presence of erosions of the GM was effective and safe, improved the tolerability of treatment and increased the level of eradication of infection. The use of Esbulardi reduced the frequency and intensity of SIBO, which prevented the development of intestinal lesions.