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Are pro- and/or synbiotics beneficial in Helicobacter pylori eradication therapy in children? A narrative review

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Abstract

To assess the effect of pro- and synbiotics in the eradication therapy of Helicobacter pylori (Hp), as well as their effect on adverse effects and therapy compliance in children, a review was performed. We searched for relevant studies published in the English language in PubMed in the last 5 years. Articles were extracted using subject heading and keywords of interest to the topic. There is low-quality evidence that Lactobacillus casei, Bifidobacterium infantis, and Clostridium butyricum (only one RCT for all three) and Saccharomyces boulardii (more than 1 RCT) increase the eradication rate and decrease the adverse effects. Data with synbiotics report only a trend towards a better eradication. Heterogeneity in study designs and outcomes is a major limitation to propose evidence-based recommendations. A reduced incidence of antibiotic-associated diarrhoea is reported. Therapy compliance has been poorly studied.

   Conclusion: Due to study heterogeneity, there is very low evidence that some specific probiotics strains increase the eradication rate of Hp when added to standard eradication therapy in children. Whether this is related to immunological effects of the strain or a decrease of adverse effects is not known. More studies, especially comparative trials, are needed before the addition of pro- or synbiotics to Hp eradication treatment can be recommended in daily routine.

What is Known:

• Eradication treatment of Helicobacter pylori in children has a low success rate and induces frequently adverse effects.

• The addition of probiotics might improve eradication and decrease adverse effects, but no paediatric guideline does recommend probiotics as part of the eradication treatment.

What is New:

• There is low-quality evidence that Lactobacillus casei, Bifidobacteria infantis, and Clostridium butyricum (only one randomized controlled trial (RCT) for all three) and Saccharomyces boulardii (more than 1 RCT) increase the eradication rate and decrease the adverse effects.

• Data with synbiotics report only a trend towards a better eradication.

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Abbreviations

AAD:

Antibiotic-associated diarrhoea

B:

Bifidobacterium

C:

Clostridium

CFU:

Colony form unit

CI:

Confidence interval

ESPGHAN :

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Hp:

Helicobacter pylori

ISAPP:

International Scientific Organization for Probiotics and Prebiotics

L:

Lactobacillus

NASPGHAN :

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

PPI:

Proton pump inhibitor

RCT:

Randomized controlled trial

RR:

Relative risk

S:

Saccharomyces

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Authors and Affiliations

  1. Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan, 101, 1090, Brussels, Belgium

    Sari Daelemans, Elvira Ingrid Levy & Yvan Vandenplas

  2. Department of Pediatrics, C.H.U. Saint-Pierre, Free University of Brussels, Brussels, Belgium

    Virginie Deseck & Elvira Ingrid Levy

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  1. Sari Daelemans
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  2. Virginie Deseck
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Contributions

S. Daelemans and V. Deseck did the literature search and wrote the first draft. E.I. Levy and Y. Vandenplas critically reviewed and revised the manuscript for important intellectual content. Y. Vandenplas conceptualized the study. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Yvan Vandenplas.

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Sari Daelemans and Virginie Deseck share first authorship.

Contents summary

Some pro- and synbiotics improve the eradication of Helicobacter pylori but comparative trials are needed to allow evidence-based recommendations.

Key notes

• Antibiotic resistance of Helicobacter pylori increases worldwide. 

• Pro- and synbiotics can increase the eradication rate of standard therapy and decrease adverse effects. There is low-quality evidence that Lactobacillus casei, Bifidobacterium infantis, and Clostridium butyricum (only one RCT for all three) and Saccharomyces boulardii (more than 1 RCT) increase the eradication rate. It is unclear which probiotic is the most effective.

• There is insufficient information on the effect of pro- and synbiotics on therapy compliance.

• Cost-effectiveness of eradication therapy may improve when probiotics are added to the eradication treatment.

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Daelemans, S., Deseck, V., Levy, E.I. et al. Are pro- and/or synbiotics beneficial in Helicobacter pylori eradication therapy in children? A narrative review. Eur J Pediatr 181, 3225–3234 (2022). https://doi.org/10.1007/s00431-022-04523-7

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