Saccharomyces boulardii as a Probiotic Supplement in Helicobacter pylori Eradication Therapy: A Meta-analysis

Johannes Raphael Westphal; Nadine Koch; Ramiro Vilchez-Vargas; Riccardo Vasapolli; Peter Malfertheiner; Christian Schulz

doi:10.15403/jgld-6797

Authors

Johannes Raphael Westphal Department of Medicine II, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, München; German Center for Infection Research (DZIF), Partner Site Munich, München, Germany https://orcid.org/0009-0008-4203-5216
Nadine Koch Department of Medicine II, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, München; German Center for Infection Research (DZIF), Partner Site Munich, München, Germany
Ramiro Vilchez-Vargas Department of Medicine II, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, München, Germany https://orcid.org/0000-0001-6535-8212
Riccardo Vasapolli Department of Medicine II, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, München; German Center for Infection Research (DZIF), Partner Site Munich, München, Germany https://orcid.org/0000-0001-7150-5864
Peter Malfertheiner Department of Medicine II, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, München; Medical Department Klinik of Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke Universität, Magdeburg, Germany https://orcid.org/0000-0001-8439-9036
Christian Schulz Department of Medicine II, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, München; German Center for Infection Research (DZIF), Partner Site Munich, München, Germany https://orcid.org/0000-0003-1841-1337

DOI:

https://doi.org/10.15403/jgld-6797

Keywords:

Saccharomyces boulardii, Helicobacter pylori, Helicobacter pylori eradication, probiotic, Meta-Analysis, H. pylori treatment, H. pylori eradication, H. pylori

Abstract

Background and Aims: Helicobacter pylori (H. pylori) is an obligate pathogen affecting approximately 50% of the world population. With rising antibiotic resistance rates in H. pylori and increasing dropout rates from eradication therapies due to adverse effects, H. pylori treatment is increasingly challenged. Saccharomyces boulardii (S. boulardii), a probiotic yeast, was shown to reduce infection- and therapy-associated adverse events and increase H. pylori eradication rates. Our meta-analysis summarizes the beneficial effects of S. boulardii supplementation on H. pylori eradication and therapy-associated side effects.

Methods: We conducted a systematic literature review and meta-analysis on PubMed, Cochrane Library, and Google Scholar from inception (1993) to October 24, 2024. Research and analysis were performed in accordance with the ‘Preferred Reporting Items of Systematic Reviews and Meta-Analyses’ (PRISMA) guidelines.

Results: The supplementation of S. boulardii to H. pylori therapy caused a significant increase in overall eradication rates and a significant decrease in overall diarrhea, nausea, and epigastric pain rates. Subgroup analysis showed that S. boulardii supplementation also decreased taste disturbance rates in patients receiving triple therapy. Symptoms, such as meteorism, vomiting, and urticaria/rash, were not significantly reduced through the supplementation of S. boulardii.

Conclusions: S. boulardii was shown to be an effective add-on to H. pylori eradication therapy. Significant improvements in eradication and frequency of the most common adverse events were observed. However, more studies are needed to validate those findings for patients receiving bismuth-based quadruple therapy.