pylori eradication rates between probiotic and

pylori eradication rates between probiotic and HSP inhibitor placebo group (45.5 vs 37.5%; p = NS) [71]. In a study of our group, aimed to evaluate the efficacy of probiotics to reduce antibiotic side effects, we found no differences in the eradication rates according to the presence/absence of the probiotic: treatment was successful in 17 of 20 patients supplemented

with L. reuteri ATCC 55730 (SD2112) as compared to 16 of 20 patients in the placebo group (85 vs 80%; p = NS) [72]. Recently, in a double-blind placebo-controlled randomized clinical trial performed in 66 children no difference was found with respect to H. pylori eradication rates between children receiving standard triple therapy supplemented with L. rhamnosus GG or placebo (69 vs 68%; p = NS) [77]. Pooled data, derived from children and adults’ studies Selleckchem Staurosporine on more than 1900 treated patients, show eradication

rates of 82.5% (95%CI: 80.1–84.7%) in patients with probiotic supplementation as compared to 73.7% (95%CI: 71–76.4%) in patients receiving placebo (RR: 1.11; 95%CI: 1.07–1.17). These data do not represent convincing evidence to support the use of probiotics as an adjunct with the aim of increasing the H. pylori eradication rate. Nevertheless, further studies are needed to clarify their role in this particular issue. The major limit to establish whether a probiotic is able to significantly increase the eradication rate is represented by the power of the study. Indeed, due to the high eradication rates that we mostly achieve with standard antibiotic treatment, to detect a 10% increase in eradication (secondary to the use of a probiotic strain), given a power of al least 80% and an alpha error level of 5%, 150 patients in each arm are needed to be enrolled. In our own experience on 40 adults, we were able to demonstrate a favorable effect of L. reuteri ATCC 55730 (SD2112) on dyspeptic symptoms

induced by H. pylori [56]. In this study, L. reuteri administration was followed by a significant decrease in the Gastrointestinal Symptom Rating Scale (GSRS) as compared to pre-treatment value (7.9 ± 4.1 vs 11.8 ± 8.5; p < .05) that was not observed before in patients receiving placebo (9.7 ± 8.7 vs 11.4 ± 9.7; p < NS) [56]. Not all probiotic strains are able do decrease dyspeptic symptoms [53] suggesting that the effect is strain specific. No data are available in the pediatric age. Bacterial resistance and antibiotic’ side-effects represent the most frequent cause for anti-H. pylori treatment failure in clinical practice [9]. Several studies evaluated whether probiotic supplementation might help to prevent or reduce drug-related side effects during H. pylori eradication therapy in adults [61,63,64,66,68,69,72–75,78–80]. All showed that diarrhea, nausea and taste disturbances were significantly reduced by probiotics and overall they were superior to placebo for side effect prevention.

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