Review: eradication therapy supplemented by probiotics increased eradication rates and reduced side effects in H pylori infection

摘要

The review by Tong ef aladds to the growing evidence that probiotics may be beneficial in a varietyfof gastrointestinal (Gl) diseases. Probiotics are attracting increasing attention because aspects of human health may relate to the balance of endogenous bacterial flora in the Gl tract, and factors that disrupt this balance may be the cause of disease. Evidence from RCTs has suggested that probiotics may be effective in reducing symptoms of both acute infective diarrhoea and antibiotic associated diarrhoea.This is an interesting systematic review but there are some concerns. As with many other systematic reviews in this area, a tendency exists to evaluate all probiotics together for a given disease. This notion is biologically implausible. All antibiotics are not equally effective in eradicating H pylori, and probiotics probably differ in their efficacy in enhancing the activity of eradication regimens. It is also unclear whether probiotics have a direct effect in increasing eradication of H pylori or whether the effect is mediated by increased compliance with antibiotics. The review was well done but the evidence identified has some weaknesses. 6 of 14 included RCTs were of poor quality with a Jadad score <3. Also, larger trials showed less of an effect on H pylori eradication. Although this imbalance did not reach formal statistical significance, publication bias and other small study effects have also been noted in systematic reviews of probiotics in other areas.On balance, this systematic review is interesting, but caution should be exercised in over interpreting the results. More data would be desirable to inform treatment.