Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis

BACKGROUND: Due to decreasing eradication rate and increasing side effects, probiotics have gradually become an important supplement to standard eradication regimens for Helicobacter pylori. OBJECTIVE: To evaluate the effectiveness and safety of probiotics in facilitating the eradication of H pylori...

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Autores principales: Shi, Xiaoguang, Zhang, Junhong, Mo, Lingshan, Shi, Jialing, Qin, Mengbin, Huang, Xue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485819/
https://www.ncbi.nlm.nih.gov/pubmed/30985706
http://dx.doi.org/10.1097/MD.0000000000015180
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author Shi, Xiaoguang
Zhang, Junhong
Mo, Lingshan
Shi, Jialing
Qin, Mengbin
Huang, Xue
author_facet Shi, Xiaoguang
Zhang, Junhong
Mo, Lingshan
Shi, Jialing
Qin, Mengbin
Huang, Xue
author_sort Shi, Xiaoguang
collection PubMed
description BACKGROUND: Due to decreasing eradication rate and increasing side effects, probiotics have gradually become an important supplement to standard eradication regimens for Helicobacter pylori. OBJECTIVE: To evaluate the effectiveness and safety of probiotics in facilitating the eradication of H pylori and to explore the best timing and duration of probiotic supplementation, use of eradication regimens, strains, locations, and common side effects. METHODS: Eligible studies were retrieved from the PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI databases, and we applied the Stata 12.0 software for the standard meta-analysis and network meta-analysis. RESULTS: Forty eligible studies with 8924 patients were included in the analysis. We used a random-effects model (I(2) = 52.1% and I(2) = 81.4%) to analyze the eradication rate and the incidence of total side effects by intention to treat (ITT). Compared with the control group, a higher eradication rate (relative risk [RR] 1.140, 95% confidence interval (CI) 1.101–1.180, P < .001) and lower incidence of total side effects (RR 0.470, 95% CI 0.391–0.565, P < .001) were observed in the probiotic group. In the subgroup analysis, we evaluated the surface under the cumulative ranking curve scores for the before + same (75.2%), >2 weeks (92.6%), probiotic + quadruple regimen (99.9%), Lactobacillus (73.6%), multiple strains (72.1%), China (98.5%) groups. The rankings of common side effects are shown in Table 6. SUCRA scores for diarrhea (39.7%), abdominal pain (43.9%), nausea (78.8%), taste disturbance (99.6%), vomiting (7.1%), and constipation (30.9%) were reported. The consistency of all comparison groups was good. CONCLUSIONS: Probiotics improved the eradication rate and reduced side effects when added to the treatments designed to eradicate H pylori. The use of probiotics before the eradication treatment and throughout the eradication treatment, and also the use of probiotics for more than 2 weeks, exerted better eradication effects. Probiotics combined with the bismuth quadruple regimen was the best combination. Lactobacillus and multiple strains were better choices of probiotic strains. The eradication effect observed in China was better than the effect observed in other countries.
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spelling pubmed-64858192019-05-29 Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis Shi, Xiaoguang Zhang, Junhong Mo, Lingshan Shi, Jialing Qin, Mengbin Huang, Xue Medicine (Baltimore) Research Article BACKGROUND: Due to decreasing eradication rate and increasing side effects, probiotics have gradually become an important supplement to standard eradication regimens for Helicobacter pylori. OBJECTIVE: To evaluate the effectiveness and safety of probiotics in facilitating the eradication of H pylori and to explore the best timing and duration of probiotic supplementation, use of eradication regimens, strains, locations, and common side effects. METHODS: Eligible studies were retrieved from the PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI databases, and we applied the Stata 12.0 software for the standard meta-analysis and network meta-analysis. RESULTS: Forty eligible studies with 8924 patients were included in the analysis. We used a random-effects model (I(2) = 52.1% and I(2) = 81.4%) to analyze the eradication rate and the incidence of total side effects by intention to treat (ITT). Compared with the control group, a higher eradication rate (relative risk [RR] 1.140, 95% confidence interval (CI) 1.101–1.180, P < .001) and lower incidence of total side effects (RR 0.470, 95% CI 0.391–0.565, P < .001) were observed in the probiotic group. In the subgroup analysis, we evaluated the surface under the cumulative ranking curve scores for the before + same (75.2%), >2 weeks (92.6%), probiotic + quadruple regimen (99.9%), Lactobacillus (73.6%), multiple strains (72.1%), China (98.5%) groups. The rankings of common side effects are shown in Table 6. SUCRA scores for diarrhea (39.7%), abdominal pain (43.9%), nausea (78.8%), taste disturbance (99.6%), vomiting (7.1%), and constipation (30.9%) were reported. The consistency of all comparison groups was good. CONCLUSIONS: Probiotics improved the eradication rate and reduced side effects when added to the treatments designed to eradicate H pylori. The use of probiotics before the eradication treatment and throughout the eradication treatment, and also the use of probiotics for more than 2 weeks, exerted better eradication effects. Probiotics combined with the bismuth quadruple regimen was the best combination. Lactobacillus and multiple strains were better choices of probiotic strains. The eradication effect observed in China was better than the effect observed in other countries. Wolters Kluwer Health 2019-04-12 /pmc/articles/PMC6485819/ /pubmed/30985706 http://dx.doi.org/10.1097/MD.0000000000015180 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle Research Article
Shi, Xiaoguang
Zhang, Junhong
Mo, Lingshan
Shi, Jialing
Qin, Mengbin
Huang, Xue
Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis
title Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis
title_full Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis
title_fullStr Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis
title_full_unstemmed Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis
title_short Efficacy and safety of probiotics in eradicating Helicobacter pylori: A network meta-analysis
title_sort efficacy and safety of probiotics in eradicating helicobacter pylori: a network meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485819/
https://www.ncbi.nlm.nih.gov/pubmed/30985706
http://dx.doi.org/10.1097/MD.0000000000015180
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