H. pylori: adding Lactobacillus to triple therapy increased eradication rates

Clinical bottom line (level 1b)

  1. Patients with dyspepsia and an H. pylori infection who took triple therapy and Lactobacillus acidophilus compared with triple therapy alone had higher eradication rates (NNT = 6 at weeks) .
  2. There was no clear difference in adverse effects between the two groups.
Canducci et al: Aliment Pharmacol Ther 2000; 14 : 1625-1629
Expires January 2004

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, Italy

120 patients (aged mean 38, 53% male) with dyspepsia and an H. pylori infection (confirmed on endoscopy)

Excluded if
  • previous treatment for H. pylori
  • on drugs that might interfere with H.pylori status (antibiotics, H-2 blockers, proton-pump inhibitors, bismuth compounds)

Control Group: (n = 60, 58 analysed): triple therapy
Experimental Group: (n = 60, 59 analysed): triple therapy plus inactivated Lactobacillus acidophilus for 10 days
All patients received rabeprazole 20 mg twice daily, clarithromycin 250 mg three times a day, amoxicillin 500 mg three times a day for 7 days.
98% followed for - weeks
Outcome notes:
  • H. pylori eradication : confirmed on 2 antral biopsies and 13-C breath test
  • adverse effects : nausea, diarrhoea, abdominal pain

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
H. pylori eradication weeks 42
(70.0%)		 52
(86.7%)		 24%
(2% to 50%)		 16.7%
(2.23% to 31.1%)		 6
(3 to 45)
adverse effects weeks 10
(16.7%)		 10
(16.7%)		 0%
(-120% to 55%)		 0.0%
(-13.3% to 13.3%)		 -
(NNT = 7 to infinity;
NNH = 7 to infinity)

Citation

  1. Canducci F, Armuzzi A, Cremonini F, et al: a lyophilized and inactivated culture of Lactobacillus acidophilus increases Helicobacter pylori eradication rates. Aliment Pharmacol Ther 2000; 14 : 1625-1629
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, January 2002
Reviewer:

Clinical Question.
Patient dyspepsia, H. pylori infection
Intervention or Exposure Lactobacillus acidophilus and triple therapy
Comparison triple therapy
Outcome eradication