Related Experiment Video
Updated: Sep 27, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Adjunctive Synbiotic Therapy for Helicobacter pylori Eradication: An Updated Systematic Review and Meta-Analysis of
Chonticha Romyasamit1,2,3, Thitinat Duangchan1,2, Yosita Leepromma1
1Department of Medical Technology, School of Allied Health Sciences, Walailak University, Thasala 80160, Nakhon Si Thammarat, Thailand.
Background:
Synbiotics may improve the effectiveness of antibiotic-based Helicobacter pylori eradication therapy; however, the available evidence remains limited. This systematic review and meta-analysis updated the evidence on the efficacy and safety of adjunctive synbiotics for H. pylori eradication and treatment-related adverse events.
Methods:
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines and was registered in PROSPERO (CRD420251236314). PubMed, Scopus, Embase, MEDLINE, Web of Science, and Google Scholar were searched from inception to their respective final search dates in November and December 2025 for randomized controlled trials comparing antibiotic-based eradication therapy plus a synbiotic with the corresponding regimen without synbiotics. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for intention-to-treat (ITT), per-protocol (PP), and safety outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE approach.
Results:
Six randomized controlled trials enrolling 486 participants were included; 446 participants contributed to the ITT analysis and 416 to the PP analysis. One trial was judged to be at high risk of bias, whereas five raised some concerns. The ITT analysis demonstrated improved eradication with adjunctive synbiotics (RR 1.18, 95% CI 1.04-1.34; I2 = 44.53%). No significant benefit was observed in the PP analysis (RR 1.06, 95% CI 0.95-1.18; I2 = 48.40%). Safety data were available from three pediatric trials (n = 230), with low-certainty evidence suggesting fewer overall adverse events (RR 0.27, 95% CI 0.16-0.45).
Conclusions:
Adjunctive synbiotics may modestly improve H. pylori eradication and may reduce overall adverse events. However, the eradication benefit was not confirmed in PP analyses, and the safety findings should be interpreted cautiously given the limited pediatric evidence.
Related Concept Videos
01:16Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:28Acid Suppressive Drugs for Peptic Ulcer Disease: Histamine H2-Receptor Antagonists
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:13Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...