Effect of Pretreatment with Lactobacillus delbrueckii and Streptococcus thermophillus on Tailored Triple Therapy for Helicobacter pylori Eradication: A Prospective Randomized Controlled Clinical Trial

Background: Helicobacter pylori plays an important role in gastric cancer and typical eradication regimensare no longer effective in many countries, including Thailand. The aim of our study was to compare the effectof Lactobacillus delbrueckii and Streptococcus thermophillus on tailored triple therapy for Helicobacter pylorieradication. Materials and
Methods: This prospective single-center study was conducted in Thailand. Helicobacterpylori associated gastritis patients were randomized to 2 groups: group 1 (n=100) was tailored triple therapywith placebo (esomeprazole 20 mg bid, clarithromycin 500 mg bid or metronidazole 400 mg tid if clarithromycinresistance and amoxicillin 1000 mg bid), and group 2 was tailored triple therapy plus pretreatment with probioticcontaining yogurt. Successful eradication was defined as both negative histology and negative rapid urease testat four weeks after treatment.
Results: A total of 200 infected patients were enrolled. PP analysis involved 194patients: 96 in the tailored triple therapy with placebo group (group 1) and 98 the in tailored triple therapyplus pretreatment with probiotic containing yogurt group (group 2). Successful eradication was observed in170 (87.6%) patients; by PP analysis, the eradication rate was significantly higher in group 2 (P = 0.04, 95%CI;0.02-0.13) than in group 1. ITT analysis also showed that the value was significantly higher in the tailored triplethreapy plus pretreatment with probiotic containing yogurt group (group 2) (89/100; 89%) than in the tailoredtriple therapy with placebo group (group 1) (P= 0.01, 95%CI; 0.04-0.15). In terms of adverse events, there wasno significant difference between the two groups.
Conclusions: Pretreatment with probiotic containing yogurtcan improve Helicobacter pylori eradication rates with tailored triple therapy. Adding probiotics does not reduceadverse effects of the medication.