Efficacy and safety of eradication therapy regimens against Helicobacter pylori infection: Focus on the combination with probiotics

Helicobacter pylori (H. pylori) infection affects 30–50% of the population in developing countries, reaching up to 90% in some regions. The infection is associated with chronic gastritis, peptic ulcer disease, gastric cancer, and MALT lymphoma. Standard eradication regimens (e.g., triple therapy) demonstrate declining efficacy (71–74.8%) due to antibiotic resistance and high rates of adverse effects (up to 50% of patients). The aim of this review was to evaluate the potential of probiotics – particularly multistrain formulations – as an adjunct therapy to a standart H.pylori eradication scheme. A narrative review of the current literature was conducted, including systematic reviews, meta-analyses (including 19 randomized controlled trials with n = 2 730), and clinical studies (including retrospective and double-blind, placebo-controlled trials), to evaluate the efficacy and safety of probiotic support. Multistrain probiotics (e.g., Lactobacillus acidophilus / Bifidobacterium animalis or 8-strain mixtures) significantly improve eradication rates (up to 90% vs 70% in controls) and reduce adverse effects, especially antibiotic-associated diarrhea. A meta-analysis of 40 studies (n = 8 924) showed a 14% increase in successful eradication with probiotics (relative risk 1.140, 95% CI 1.101–1.180; p < 0.001). Multistrain products exert synergistic effects via multiple mechanisms: immune modulation, antimicrobial activity (via short-chain fatty acids), mucosal barrier protection, competitive inhibition of H. pylori, and microbiota restoration. Clinical trials (e.g., with the multistrain probiotic Bac Set) confirm better stool normalization and microbiota preservation compared to monostrain options. Multistrain probiotics represent a promising strategy to optimize H. pylori eradication. They enhance treatment efficacy, reduce adverse effects, and support gastrointestinal microbiota recovery. Current guidelines (e.g., Maastricht VI/Florence and World Gastroenterology Organisation, 2023) endorse their use for minimizing side effects and improving outcomes, especially in combination with bismuth-containing quadruple therapy.

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