A Systematic Review and Meta‐Analysis of Randomized Controlled Trials on the Benefits of Using Lactobacillus Supplements as an Adjunct Treatment for <i>Helicobacter pylori</i> Eradication

Supplementing H. pylori treatment with probiotics like Lactobacillus has become an essential approach due to the possible adverse effects of antibiotic therapy and the need to increase overall eradication rates. Although several types of Lactobacillus strains as probiotics were efficient in treating H. pylori, their relative efficiency in treating H. pylori was uncertain. A survey of databases, including PubMed, Cochrane, Google Scholar, Scopus, and Clinicaltrials.gov, retrieved 52 Randomized Controlled Trials (RCTs), with 14 meeting the criteria for RCTs on Lactobacillus supplementation (LS) as an adjunct therapy compared to placebo in adult H. pylori patients. Analyses were conducted using RevMan5.3, Cochrane Risk of Bias Tool, Comprehensive Meta-Analysis Software, and GRADEpro. Fourteen RCTs, including 2054 patients with more than ten different probiotics, were included in this analysis. The LS group showed significantly higher H. pylori eradication rates [RR = 1.04 (95% CI: 1.01, 1.07; p = 0.009; I² = 0%); (high certainty)], decreased AEs including vomiting [RR = 0.82 (95% CI: 0.48, 1.41; p = 0.48; I² = 19%); (high certainty)], diarrhea [RR = 0.45 (95% CI: 0.26, 0.80; p = 0.007; I² = 55%); (high certainty)], abdominal pain [RR = 0.73 (95% CI: 0.28, 1.93; p = 0.53; I² = 66%); (high certainty)], anorexia [RR = 0.79 (95% CI: 0.23, 2.64; p = 0.70; I² = 0%); (high certainty)], constipation [RR = 1.02 (95% CI: 0.42, 2.50; p = 0.96; I² = 0%); (high certainty)], rash [RR = 1.51 (95% CI: 0.57, 3.98; p = 0.41; I² = 0%); (high certainty)], taste disturbance [RR = 0.64 (95% CI: 0.44, 0.92; p = 0.02; I² = 51%); (moderate certainty)], and reduction of gastrointestinal symptoms including abdominal pain [SMD = -0.19 (95% CI: -0.46, 0.09; p = 0.18; I² = %); (moderate certainty)]. None of the included RCTs depicted a high risk of bias. Lactobacillus added to triple or quadruple therapy increased eradication rates, but improvements in adverse effects and gastrointestinal symptoms were not significant. Multiple different strains limited assessment of individual effectiveness, preventing firm conclusions about the specific impact of each Lactobacillus type.