INTRODUCTION: – To evaluate the prescription patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe. METHODS: – International, prospective, noninterventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AEs) were categorized as mild, moderate, and severe. RESULTS: – Overall, 36, 699 treatments were recorded, where 8, 233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (odds ratio [OR] 1.631, 95% confidence interval [CI] 1.456–1.828), as well as in triple (OR 1.702, 95% CI 1.403–2.065), quadruple (OR 1.383, 95% CI 0.996–1.920), bismuth quadruple (OR 1.248, 95% CI 1.003–1.554), and sequential therapies (OR 3.690, 95% CI 2.686–5.069). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR 2.625, 95% CI 1.911–3.606) and bismuth quadruple (OR 1.587, 95% CI 1.117–2.254) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (OR 0.656, 95% CI 0.516–0.888) and severe AEs (OR 0.312, 95% CI 0.217–0.449). Bifidobacterium genus was associated with lower overall (OR 0.725, 95% CI 0.592–0.888) and severe (OR 0.254, 95% CI 0.185–0.347) AEs, and Saccharomyces was associated with reduced overall (OR 0.54, 95% CI 0.32–0.91) and severe (OR 0.257, 95% CI 0.123–0.536) AEs under quadruple-bismuth regimen. DISCUSSION: – In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, whereas Bifidobacterium and Saccharomyces were associated with a better safety profile.
Casas Deza, D., Alcedo, J., Lafuente, M., López, F. J., Perez-Aisa, Á., Pavoni, M., Tepes, B., Jonaitis, L., Castro-Fernandez, M., Pabón-Carrasco, M., Keco-Huerga, A., Voynovan, I., Bujanda, L., Lucendo, A. J., Brglez Jurecic, N., Denkovski, M., Vologzanina, L., Rodrigo, L., Martínez-Domínguez, S. J., Fadieienko, G., Huguet, J. M., Abdulkhakov, R., Abdulkhakov, S. R., Alcaide, N., Velayos, B., Hernández, L., Bordin, D. S., Gasbarrini, A., Kupcinskas, J., Babayeva, G., Gridnyev, O., Leja, M., Rokkas, T., Marcos-Pinto, R., Lerang, F., Boltin, D., Mestrovic, A., Smith, S. M., Venerito, M., Boyanova, L., Milivojevic, V., Doulberis, M., Kunovsky, L., Parra, P., Cano-Català, A., Moreira, L., Nyssen, O. P., Megraud, F., Morain, C. O., Gisbert, J. P., Probiotics Prescribed With Helicobacter pylori Eradication Therapy in Europe: Usage Pattern, Effectiveness, and Safety. Results From the European Registry on Helicobacter pylori Management (Hp-EuReg), <<THE AMERICAN JOURNAL OF GASTROENTEROLOGY>>, N/A; 120 (11): 2644-2659. [doi:10.14309/ajg.0000000000003351] [https://hdl.handle.net/10807/330765]
Probiotics Prescribed With Helicobacter pylori Eradication Therapy in Europe: Usage Pattern, Effectiveness, and Safety. Results From the European Registry on Helicobacter pylori Management (Hp-EuReg)
Gasbarrini, Antonio;
2025
Abstract
INTRODUCTION: – To evaluate the prescription patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe. METHODS: – International, prospective, noninterventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AEs) were categorized as mild, moderate, and severe. RESULTS: – Overall, 36, 699 treatments were recorded, where 8, 233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (odds ratio [OR] 1.631, 95% confidence interval [CI] 1.456–1.828), as well as in triple (OR 1.702, 95% CI 1.403–2.065), quadruple (OR 1.383, 95% CI 0.996–1.920), bismuth quadruple (OR 1.248, 95% CI 1.003–1.554), and sequential therapies (OR 3.690, 95% CI 2.686–5.069). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR 2.625, 95% CI 1.911–3.606) and bismuth quadruple (OR 1.587, 95% CI 1.117–2.254) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (OR 0.656, 95% CI 0.516–0.888) and severe AEs (OR 0.312, 95% CI 0.217–0.449). Bifidobacterium genus was associated with lower overall (OR 0.725, 95% CI 0.592–0.888) and severe (OR 0.254, 95% CI 0.185–0.347) AEs, and Saccharomyces was associated with reduced overall (OR 0.54, 95% CI 0.32–0.91) and severe (OR 0.257, 95% CI 0.123–0.536) AEs under quadruple-bismuth regimen. DISCUSSION: – In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, whereas Bifidobacterium and Saccharomyces were associated with a better safety profile.
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