Helicobacter pylori (H. pylori) is a spiral-shaped gram-negative bacterium that can colonize the human stomach and cause chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Treatment of H. pylori infection typically involves the use of antibiotics, and the most common regimens are triple therapy and quadruple therapy, often a combination of a proton pump inhibitor (PPI) and two antibiotics. In the 1980s, H. pylori was discovered as the causative agent of peptic ulcer disease, and treatment initially consisted of acid suppression therapy alone. Later, it was discovered that antibiotics could be used to eradicate H. pylori, and a combination of antibiotics and acid suppression therapy became the standard treatment for H. pylori infection. However, antibiotic resistance has become a significant problem, and the efficacy of treatment has declined in recent years. The bacterium can be eradicated with a combination of antibiotics and acid suppressants, but antibiotic resistance has become a significant problem that can reduce the efficacy of treatment. The World Health Organization (WHO) has identified H. pylori as a global priority pathogen due to its increasing prevalence and the emergence of antibiotic resistance.
It has been demonstrated that probiotics can effectively enhance the eradication rate of H. pylori and reduce the incidence of antibiotic-associated adverse effects such as diarrhea and abdominal pain. In a metaanalysis of randomized controlled trials, it was found that the use of many probiotic combinations (L. acidophilus/B. animalis, L. helveticus/L. rhamnosus, L. acidophilus/B. longum/E. faecalis, and the eight-strain mixture) was significantly effective (eradication rates higher than 90%) as an adjunct therapy for the eradication of H. pylori (OR: 1.53, 95% CI: 1.23-1.90) and a substantial reduction in the incidence of antibiotic-associated side effects (OR: 0.54, 95% CI: 0.40-0.72). However, the optimal strains and dosages of probiotics have yet to be established, and further research is needed to determine the most effective probiotic regimens. 
At present, quadruple therapy and Lactobacillus-containing quadruple therapy have been proposed as novel and effective therapeutic regimens for H. pylori infection. Lactobacillus-containing quadruple therapy consists of a PPI, bismuth, metronidazole, and a probiotic containing Lactobacillus and has been shown to be more effective than quadruple therapy for H. pylori eradication.
Research shows that two mechanisms by which probiotic bacteria can inhibit H. pylori. (1) Probiotics may inhibit H. pylori growth by secreting antibacterial substances and inhibiting the attachment of H. pylori to gastrointestinal mucosa. (2) Probiotics are capable of up-regulating IL-10. It is possible that increased levels of IL-10 may have contributed to the observed the decrease in H. pylori-specific IgG antibodies. This cytokine has previously been shown to down-regulate H. pylori-specific antibody production.
Combined use of antibiotics and probiotics that inhibit H. pylori can increase the effect of eradicating H. pylori, and this treatment method can be used clinically in patients who have failed the triple therapy or quadruple therapy.
  1. Prabhav Kashyap Godavarthy and Chandra Puli. From Antibiotic Resistance to Antibiotic Renaissance: A New Era in Helicobacter pylori Treatment. 2023 Godavarthy et al. Cureus 15(3): e36041. DOI 10.7759/cureus.36041
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