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)

Casas Deza D 1 , Alcedo J 1 , Lafuente M 2 , López FJ 2 , Perez-Aisa Á 3 , Pavoni M 4 Show all authors , Tepes B 5 , Jonaitis L 6 , Castro-Fernandez M 7 , Pabón-Carrasco M 7 , Keco-Huerga A 7 , Voynovan I 8 , Bujanda L 9 , Lucendo AJ 10 , Brglez Jurecic N 11 , Denkovski M 11 , Vologzanina L 12 , Rodrigo L 13 , Martínez-Domínguez SJ 14 , Fadieienko G 15 , Huguet JM 16 , Abdulkhakov R 17 , Abdulkhakov SR 17 , Alcaide N 18 , Velayos B 18 , Hernández L 19 , Bordin DS 20 , Gasbarrini A 21 , Kupcinskas J 6 , Babayeva G 22 , Gridnyev O 15 , Leja M 23 , Rokkas T 24 , Marcos-Pinto R 25 , Lerang F 26 , Boltin D 27 , Mestrovic A 28 , Smith SM 29 , Venerito M 30 , Boyanova L 31 , Milivojevic V 32 , Doulberis M 33 , Kunovsky L 34 , Parra P 35 , Cano-Català A 36 , Moreira L 37 , Nyssen OP 35 , Megraud F 38 , Morain CO 29 , Gisbert JP 35 , Hp-EuReg investigators

Affiliations 

  • 1 Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
  • 2 Department of Statistical Methods, Faculty of Science, Universidad de Zaragoza, Zaragoza, Spain
  • 3 Digestive Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain
  • 4 Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
  • 5 Department of Gastroenterology, DC Rogaska, Slatina, Slovenia
  • 6 Research and Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 7 Department of Gastroenterology, Hospital Universitario de Valme, Seville, Spain
  • 8 Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
  • 9 Department of Gastroenterology, Biodonostia Health Research Institute, San Sebastián, Spain
  • 10 Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
  • 11 Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, Bled, Slovenia
  • 12 Gastrocenter, Perm, Russia
  • 13 Gastroenterology, University of Oviedo, Oviedo, Spain
  • 14 Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
  • 15 Departments the Division for the Study of the Digestive Diseases and Its Comorbidity With Noncommunicable Diseases, Government Institution L.T. Malaya Therapy National Institute of NAMS of Ukraine, Kharkiv, Ukraine
  • 16 Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain
  • 17 Department of Hospital Medicine, Kazan State Medical University, Kazan, Russia
  • 18 Department of Gastroenterology, Hospital Clínico de Valladolid, Valladolid, Spain
  • 19 Gastroenterology Unit, Hospital Santos Reyes, Aranda de Duero, Spain
  • 20 Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
  • 21 Medicina interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  • 22 Department of Internal Medicine and Gastroenterology, Azerbaijan State Advanced Training Institute for Doctors named by A. Aliyev, Baku, Azerbaijan
  • 23 Department of Gastroenterology, Digestive Diseases Centre, Riga, Latvia
  • 24 Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
  • 25 Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
  • 26 Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
  • 27 Division of Gastroenterology, Rabin Medical Center, TelAviv, Israel
  • 28 Department of Gastroenterology, University Hospital of Split, Split, Croatia
  • 29 School of Medicine, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
  • 30 Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany
  • 31 Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria
  • 32 Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
  • 33 Gastroenterology Department, Kantonsspital Aarau, Aarau, Switzerland
  • 34 2nd Department of Internal Medicine-Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
  • 35 Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
  • 36 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) Research Group, Althaia Xarxa Assistencial Universitària de Manresa FP, Manresa, Spain
  • 37 Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
  • 38 INSERM U1312 BRIC, Université de Bordeaux, Bordeaux, France
Am J Gastroenterol, 2025 Feb 04.
PMID: 39902822 DOI: 10.14309/ajg.0000000000003351

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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