The Role of Probiotics in the Eradication of Helicobacter pylori and Overall Impact on Management of Peptic Ulcer: A Study Involving Patients Undergoing Triple Therapy in Bangladesh

Abstract

Background Helicobacter pylori infection has been identified to cause constantly recurring inflammation, leading to gastrointestinal tract disorders, including carcinoma. The standard triple therapy (STT), used to eradicate H. pylori, includes two antimicrobials and a proton pump inhibitor for two weeks. Other drug regimens have also been developed since H. pylori exhibits antimicrobial resistance. These regimens, including probiotics, have been shown to lower adverse drug reactions (ADR), improve drug adherence, exert bacteriostatic effect, and reduce inflammation. Objective This study intended to explore probiotic intervention for improving eradication rates and mitigating adverse effects while administrating STT. Methods This prospective study was conducted from May to December, 2021, in the Department of Gastroenterology of Ship International Hospital, Dhaka, Bangladesh, to observe the effects of probiotics inclusion along with STT on H. pylori eradication. A total of 100 patients aged ≥18 years who tested positive for H. pylori were included. The experimental group (n=50) was given STT and probiotics, and the control group (n=50) was given only STT without probiotics for 14 days. Necessary follow-up was done six weeks after treatment. An independent sample t-test, chi-square test, and multiple regression analysis were used for statistical analysis. Result The odds of getting rapid urease test (RUT) negative results from positive were 2.06 times higher (95%CI= 0.95, 3.22, p=0.054) in the experimental group. ADRs were crucially towering in the control group (p=0.045) compared to the probiotics group. The probiotics group had a lower risk of having adverse effects by 0.54 times (95%CI=0.19, 0.84, p=0.032) than the control group. Conclusion Using probiotics and STT together to eradicate H. pylori may lower ADR and improve treatment adherence. It may also help terminate H. pylori infection more effectively. More research is required as H. pylori is very contagious and can ultimately cause life-threatening gastric cancer.

Keywords: bangladesh; h. pylori treatment; helicobacter pylori; peptic ulcer disease; probiotic bacterium; probiotic microflora; pud; triple therapy.

Figure 1. Schematic diagram showing the methodology of this study.

Image credit: Sismita Sinha; with the premium version of BioRender [114] with the license number HM26K5BNK0

Figure 2. The odds ratio of RUT risk becoming negative in the supplementation group compared to the group without probiotics.

A multilevel mixed-effect model was used to analyze the OR of RUT. The analysis considered potential confounders that affected the model by >5% (age, sex, history of morbidities, and smoking history). RUT: rapid urease test Image Credit: Md. Ahsanul Haq

Figure 3. Risk of having adverse effects of triple therapy in the probiotics group compared to the non-probiotic group.

The logistic regression model was used to estimate the p-value, and the regression model was adjusted by age, sex, history of hypertension, history of multiple comorbidities, history of smoking, and history of taking NSAIDs. NSAID: non-steroidal anti-inflammatory drugs Image Credit: Md. Ahsanul Haque.

Figure 4. Risk of adverse effects in triple therapy with probiotics group compared to triple medications excluding probiotics. No adverse impact was used as reference (1) for all measured events.

The logistic regression model was used to estimate the p-value, and the regression model was adjusted by age, sex, history of hypertension, history of multiple comorbidities, history of smoking, and history of taking NSAIDs. NSAID: non-steroidal anti-inflammatory drug; PPI: proton pump inhibitor Image Credit: Md. Ahsanul Haq

Figure 5. Beneficial effects of adding probiotics to the standard triple therapy on patients with H. pylori infection.

H. pylori: Helicobacter pylori Image credit: Rahnuma Ahmad; with the premium version of BioRender [114] with license number CH26GB4NBY.

Figure 6. Selected consequential papers showing the benefits of adding probiotics with standard therapy for Helicobacter pylori eradication.

Notes: Keywords were “Benefits,” “Probiotics,” “Helicobacter pylori,” “Eradication,” and “Triple therapy.” Filters Applied: Randomized Controlled Trials. Indexed in PubMed. References: [165-168] Image Credit: Md. Ahsanul Haq

Figure 7. Principal findings of the current study

ADR: adverse drug reaction Image Credit: Rahnuma Ahmad; with the premium version of BioRender [114] with license number XA26G8WP6M