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. 2025 Feb 4.
doi: 10.14309/ajg.0000000000003351. Online ahead of print.

Probiotics Prescribed With Helicobacter pylori Eradication Therapy in Europe: Usage Pattern, Effectiveness, and Safety. Results From the European Registry on Helicobacter pylori Management (Hp-EuReg)

Diego Casas Deza  1   2 , Javier Alcedo  1   2 , Miguel Lafuente  3   4 , F Javier López  3   4 , Ángeles Perez-Aisa  5   6 , Matteo Pavoni  7 , Bojan Tepes  8 , Laimas Jonaitis  9 , Manuel Castro-Fernandez  10 , Manuel Pabón-Carrasco  10 , Alma Keco-Huerga  10 , Irina Voynovan  11 , Luis Bujanda  12   13   14 , Alfredo J Lucendo  15   16   17 , Natasa Brglez Jurecic  18 , Maja Denkovski  18 , Ludmila Vologzanina  19 , Luis Rodrigo  20 , Samuel J Martínez-Domínguez  2   21   22 , Galyna Fadieienko  23 , Jose M Huguet  24 , Rustam Abdulkhakov  25 , Sayar R Abdulkhakov  25 , Noelia Alcaide  26 , Benito Velayos  26 , Luis Hernández  27 , Dmitry S Bordin  28   29   30 , Antonio Gasbarrini  31 , Juozas Kupcinskas  9 , Gülüstan Babayeva  32 , Oleksiy Gridnyev  23 , Mārcis Leja  33   34 , Theodore Rokkas  35 , Ricardo Marcos-Pinto  36   37   38 , Frode Lerang  39 , Doron Boltin  40   41 , Antonio Mestrovic  42 , Sinead M Smith  43 , Marino Venerito  44 , Lyudmila Boyanova  45 , Vladimir Milivojevic  46   47 , Michael Doulberis  48 , Lumir Kunovsky  49   50   51 , Pablo Parra  52 , Anna Cano-Català  53   54 , Leticia Moreira  55 , Olga P Nyssen  52 , Francis Megraud  56 , Colm O Morain  43 , Javier P Gisbert  52 ; Hp-EuReg investigators
Collaborators, Affiliations

Probiotics Prescribed With Helicobacter pylori Eradication Therapy in Europe: Usage Pattern, Effectiveness, and Safety. Results From the European Registry on Helicobacter pylori Management (Hp-EuReg)

Diego Casas Deza et al. Am J Gastroenterol. .

Abstract

Introduction: To evaluate the prescription patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe.

Methods: International, prospective, noninterventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AEs) were categorized as mild, moderate, and severe.

Results: Overall, 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (odds ratio [OR] 1.631, 95% confidence interval [CI] 1.456-1.828), as well as in triple (OR 1.702, 95% CI 1.403-2.065), quadruple (OR 1.383, 95% CI 0.996-1.920), bismuth quadruple (OR 1.248, 95% CI 1.003-1.554), and sequential therapies (OR 3.690, 95% CI 2.686-5.069). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR 2.625, 95% CI 1.911-3.606) and bismuth quadruple (OR 1.587, 95% CI 1.117-2.254) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (OR 0.656, 95% CI 0.516-0.888) and severe AEs (OR 0.312, 95% CI 0.217-0.449). Bifidobacterium genus was associated with lower overall (OR 0.725, 95% CI 0.592-0.888) and severe (OR 0.254, 95% CI 0.185-0.347) AEs, and Saccharomyces was associated with reduced overall (OR 0.54, 95% CI 0.32-0.91) and severe (OR 0.257, 95% CI 0.123-0.536) AEs under quadruple-bismuth regimen.

Discussion: In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, whereas Bifidobacterium and Saccharomyces were associated with a better safety profile.

Trial registration: ClinicalTrials.gov NCT02328131.

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References

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