The importance of probiotics in optimizing the efficacy and safety of <i>Helicobacter pylori</i> infection eradication therapy

Abstract

Over the past decade, a large number of major studies have been published analysing the efficacy of including probiotics in the eradication therapy regimens of Helicobacter pylori (H. pylori) infection. One of the catalysts for scientific activity in this direction is undoubtedly the negative trend associated with the decrease in the effectiveness of classical eradication therapy regimens observed all over the world. To date, the results of several meta-analyses show that the addition of certain strains of probiotics to standard eradication therapy regimens increases the efficiency of eradication therapy as well as reduces the frequency of side effects of the gastrointestinal tract associated with the treatment. Mechanisms allowing to increase the efficacy of eradication therapy when using probiotics are still being actively studied. The antagonistic role of some strains of probiotics against H. pylori both in vitro and in vivo has been shown in some works. In particular, probiotics can secrete antibacterial substances including short-chain fatty acids, lactic acid, hydrogen peroxide and bacteriocin. Probiotics can prevent the colonization of H. pylori by competitively inhibiting the adhesion of the microorganism to the epithelial cells of the gastric mucosa. It should be separately noted that probiotics make an important contribution to strengthening the protective properties of the gastric mucosal barrier. Probiotics are able to increase the expression of MUC1, MUC2 and MUC3, as well as restore the compromised proteins of dense contacts of cells, thus stabilizing the structural and functional integrity of the mucous layer of the gastric barrier. Probiotics are able to modulate the immune response of the macroorganism, reducing the production of proinflammatory cytokines involved in the chemotaxis and activation of immunocompetent cells in the gastric mucosa.

Keywords

• helicobacter pylori
• eradication therapy
• amoxicillin
• clarithromycin
• probiotics
• lactobacillus
• bifidobacterium
• saccharomyces