Evaluating probiotic monotherapy in Helicobacter pylori infection: A meta-analysis of randomized controlled trials...

This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of probiotics in reducing H. pylori colonization in non-antibiotic interventions.

Systematic searches were conducted in PubMed, Scopus, Cochrane Library databases and Google Scholar. Data analysis was performed using CMA (V4) and Trial Sequential Analysis (TSA), with evidence certainty evaluated via GRADE.

Twenty-eight studies met the inclusion criteria. Compared with placebo, probiotic monotherapy significantly reduced H. pylori colonization (RR = 1.712, 95 % CI: 1.240 to 2.364, I² = 37.80, p = 0.001), but total eradication was 16.8 %. Among the probiotic strains, Lactobacillus reuteri showed higher efficacy (event rate = 0.377, 95 % CI: 0.123 to 0.722, I² = 86.00). 4 weeks supplementation period yielded a stronger effect (event rate = 0.315, 95 % CI: 0.137 to 0.570, I² = 78.18). Changes in ¹³C-UBT values, indicating bacterial load reduction, were significant (SMD = -0.617, p < 0.001, 95 % CI: -0.921 to -0.312, I² = 86.50), while gastrointestinal symptom relief scores showed moderate improvement (SMD = -0.253, p = 0.012, 95 % CI: -0.451 to -0.055, I² = 2.46). TSA validated that sufficient studies supported these findings, with evidence graded of moderate certainty.

While probiotic monotherapy, particularly L. reuteri appears to reduce H. pylori colonization and improve gastrointestinal symptoms, their effectiveness as a standalone therapy remains limited owing to low eradication rates and variability in study quality. Further well-designed trials are required to establish their optimal role, particularly as supportive or adjunctive interventions.