Efficacy and Safety of Saccharomyces Boulardii with Standard Quadruple Therapy for Eradication of Helicobacter Pylori in Adults: Meta-Analysis

Helicobacter pylori is a class I carcinogen, strongly associated with gastric cancer, gastric ulcers, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Helicobacter pylori (H. pylori) infection necessitates effective eradication strategies. This study evaluated Saccharomyces boulardii (S. boulardii) as an adjunctive therapy to standard bismuth-containing quadruple therapy for H. pylori eradication. Comprehensive searches across PubMed, Embase, Cochrane Library, CNKI, WanFang Data, CBM, and Web of Science identified relevant randomised controlled trials (RCTs). Analysis of 11 RCTs (n = 2,295 patients) demonstrated significantly higher eradication rates (78.6% to 89.2%) with adjunctive S. boulardii (n = 2,295; ITT analysis: RR = 1.12; 95% CI: 1.06-1.18; Z = 4.27, p <0.01) versus standard therapy alone. Crucially, the probiotic combination also substantially reduced treatment-related adverse events (n = 2,183; RR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002), with pronounced reductions in diarrhoea (n = 2,091; RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03) and rash occurrence (n = 1,271; RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01). These findings support S. boulardii supplementation as an effective strategy that enhances standard bismuth quadruple therapy efficacy while mitigating gastrointestinal and dermatological complications in H. pylori management. Therefore, the combination of S. boulardii and bismuth-containing quadruple therapy was effective in the treatment of H. pylori infection and has shown significant efficacy and safety as an effective and safe treatment. Key Words: Saccharomyces boulardii, Helicobacter pylori, Bismuth, Quadruple therapy.