Efficacy Of The Probiotics Combined With Bismuth-containing Quadruple Therapy For Helicobacter Pylori Eradiaction:A Meta Analysis

ObejectiveTo systematically evaluate the effect of probiotics combined with bismuth-containing quadruple therapy(BQT)on the eradication rate and side-effects of anti-Helicobacter Pylori(Hp)treatment.MethodsPublications of Randomized controlled trials on the BQT or probiotics combined with BQT to eradicate Hp were searched using electronic data bases(Wanfang,CBM,CNKI,Pub Med,Web of Science).Analyze the Risk Ratio(RR)of H.pylori eradication rate and rate of side effects.Carry on the sensitivity analysis and subgroup analysis.Show the publication bias through funnel plot.ResultsIn total,14 randomized clinical trials including 2268 cases were identified.According to intention-to-treat(ITT)analysis,the H.pylori eradication rate was85.1 %(95% :0.80～ 0.92)、 76.8%(95% 0.68～0.88)for group with or without probiotics,The summary RR =1.10(95%CI:1.04～1.16),P < 0.05.According to per-protocol set(PP)analysis,the H.pylori eradication rate of probiotics group was89.8%(95%CI:0.85～0.95)、the control group was 85.0%(95%CI:0.76～0.96);RR =1.06(95%CI:1.02～1.09),P=0.002,difference betwen two groups has statistical signifiance.According to intention-to-treat(ITT)analysis,the rate of total side effects for probiotics group was 14.2%(95%CI : 0.09 ～ 0.21),the control group was26.5%(95% CI:0.15 ～ 0.45),the summary RR was 0.51(95% :0.42 ～ 0.61),P<0.00001.According to per-protocol set analysis(PP),the rate of total side effects of probiotics group was 15.7%(95%CI : 0.10 ～ 0.22).The control group was30.8%(95% :0.18 ～ 0.50),the summary RR = 0.48(95% :0.37 ～ 0.62),P<0.00001,difference betwen two groups has statistical signifiance.Conclusions(1)Probiotics combained with bismuth-containing quadruple therapy is effective in increasing the eradication rate for H.pylori eradication.Furthermore,probiotics can reduce the rate of H.pylori therapy-related side effects;(2)Different probiotic strains may have different effects on HP eradication;(3)Probiotics used before or simultaneous BQT effect than probiotics used after BQT;(4)Probiotics combined with BQT2 weeks may be better than 4 weeks.