Can Saccharomyces boulardii treat and eradicate Helicobacter pylori among children instead of bismuth?
Abstract
Aim: The objective of this study is to compare the use of Saccharomyces boulardii (S. boulardii) in eradicating Helicobacter pylori (H. pylori) in children as an alternative to bismuth, which has a limited scope of application due to its side effects.
Material and Method: Included in the study were 220 pediatric patients with symptomatic H. pylori gastritis. The patients were randomized into three treatment groups. Patients who received bismuth or S. boulardii in addition to the standard triple therapy for 14 days were compared with the control group who received only triple therapy.
Results: Analysis of the bismuth, S. boulardii, and control groups’ treatment success showed that the H. pylori eradication rate was highest among study participants who received bismuth (95.2%), followed by patients who received S. boulardii (92.4%). The most frequent side effects were observed in the patient group that received bismuth (17.5%).
Conclusion: Although bismuth continues to be successful in eradicating H. pylori, alternative treatment protocols are necessary because of its side effects and limited use in pediatric patients. S. boulardii can be administered instead when bismuth can not serve as alternative due to its side effects.
References
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- Bayındır Bilman F, Özdemir M, Baysal B, Güzel Kurtoğlu M. Prevalence of H. pylori in gastric biopsy specimen in the southeastern region of Turkey. J Infect Dev Ctries 2016; 10: 1177-82.
- Zabala Torrres B, Lucero Y, Lagomarcino AJ, et al. Review: prevalence and dynamics of Helicobacter pylori infection during childhood. Helicobacter 2017; 22: 10.
- Kocazeybek B, Tokman HB. Prevalence of primary antimicrobial resistance of H. pylori in Turkey: a systematic review. Helicobacter 2016; 21: 251-60.
- Güven B, Gülerman F, Kaçmaz B. Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross-sectional study. Helicobacter 2019; 24: e12581.
- Papastergiou V, Georgopoulos SD, Karatapanis S. Treatment of Helicobacter pylori infection: past, present and future. World J Gastrointest Pathophysiol 2014; 5: 392-9.
- Suzuki H, Nishizawa T, Hibi T. Helicobacter pylori eradication therapy. Future Microbiol 2010; 5: 639-48.
- McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol 2010; 16: 2202-22.
- Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-81.
- Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN Guidelines for the management of Helicobacter pylori in children and adolescents (Update 2016). J Pediatr Gastroenterol Nutr 2017; 64: 991-1003.
- Kuo YT, Liou JM, El-Omar EM, et al. Primary antibiotic resistance in Helicobacter pylori in the Asia-Pacific region: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2: 707-15.
- Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization Regions. Gastroenterol 2018; 155: 1372-82.
- Arslan M, Balamtekin N, Günal A. Efficacy of a novel sequential treatment regimen containing bismuth for Helicobacter pylori eradication in Turkish children. Helicobacter 2020; 25: e12757.
- Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66: 6-30.
- Liu WZ, Xie Y, Lu H, et al. Fifth Chinese National Consensus Report on the management of Helicobacter pylori infection. Helicobacter 2018; 23: e12475.
- Burkitt MD, Duckworth CA, Williams JM, Pritchard DM. Helicobacter pylori-induced gastric pathology: insights from in vivo and ex vivo models. Dis Model Mech 2017; 10: 89-104.
- Hojo M, Nagahara A, Kudo T, et al. Endoscopic findings of Helicobacter pylori gastritis in children and young adults based on the Kyoto classification of gastritis and age-associated changes. JGH Open 2021; 5: 1197-1202.
- Keller J, Hammer HF, Afolabi PR, et al. European guideline on indications, performance and clinical impact of 13 C-breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC. United European Gastroenterol J 2021; 9: 598-625.
- Liu KS, Hung IF, Seto WK, et al. Ten day sequential versus 10 day modified bismuth quadruple therapy as empirical firstline and secondline treatment for Helicobacter pylori in Chinese patients: an open label, randomised, crossover trial. Gut 2014; 63: 1410-15.
- Liou JM, Chen CC, Chen MJ, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2013; 381: 205-13.
- Lee JY, Kim N, Park KS, et al. Comparison of sequential therapy and amoxicillin/tetracycline containing bismuth quadruple therapy for the first-line eradication of Helicobacter pylori: a prospective, multi-center, randomized clinical trial. BMC Gastroenterol 2016; 16: 79.
- Chen Y, Liu Q, Hu F, Ma J. Identifying the best regimen for primary eradication of Helicobacter pylori: analysis of 240 cases. Microbiologyopen 2021; 10: e1223.
- Zhou Y, Ye Z, Wang Y, et al. Comparison of four different regimens against Helicobacter pylori as a first-line treatment: A prospective, cross-sectional, comparative, open trial in Chinese children. Helicobacter 2020; 25: e12679.
- Szajewska H, Horvath A, Piwowarczyk A. Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther 2010; 32: 1069-79.
- Zhou BG, Chen LX, Li B, Wan LY, Ai YW. Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis. Helicobacter 2019; 24: e12651.
- Bin Z, Ya-Zheng X, Zhao-Hui D, Bo C, Li-Rong J, Vandenplas Y. The efficacy of Saccharomyces boulardii CNCM I-745 in addition to standard Helicobacter pylori eradication treatment in children. Pediatr Gastroenterol Hepatol Nutr 2015; 18: 17-22.
Abstract
References
- Kotilea K, Kalach N, Homan M, Bontems P. Helicobacter pylori ınfection in pediatric patients: update on diagnosis and eradication strategies. Paediatr Drugs 2018; 20: 337-51.
- Bayındır Bilman F, Özdemir M, Baysal B, Güzel Kurtoğlu M. Prevalence of H. pylori in gastric biopsy specimen in the southeastern region of Turkey. J Infect Dev Ctries 2016; 10: 1177-82.
- Zabala Torrres B, Lucero Y, Lagomarcino AJ, et al. Review: prevalence and dynamics of Helicobacter pylori infection during childhood. Helicobacter 2017; 22: 10.
- Kocazeybek B, Tokman HB. Prevalence of primary antimicrobial resistance of H. pylori in Turkey: a systematic review. Helicobacter 2016; 21: 251-60.
- Güven B, Gülerman F, Kaçmaz B. Helicobacter pylori resistance to clarithromycin and fluoroquinolones in a pediatric population in Turkey: A cross-sectional study. Helicobacter 2019; 24: e12581.
- Papastergiou V, Georgopoulos SD, Karatapanis S. Treatment of Helicobacter pylori infection: past, present and future. World J Gastrointest Pathophysiol 2014; 5: 392-9.
- Suzuki H, Nishizawa T, Hibi T. Helicobacter pylori eradication therapy. Future Microbiol 2010; 5: 639-48.
- McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol 2010; 16: 2202-22.
- Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-81.
- Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN Guidelines for the management of Helicobacter pylori in children and adolescents (Update 2016). J Pediatr Gastroenterol Nutr 2017; 64: 991-1003.
- Kuo YT, Liou JM, El-Omar EM, et al. Primary antibiotic resistance in Helicobacter pylori in the Asia-Pacific region: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2: 707-15.
- Savoldi A, Carrara E, Graham DY, Conti M, Tacconelli E. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization Regions. Gastroenterol 2018; 155: 1372-82.
- Arslan M, Balamtekin N, Günal A. Efficacy of a novel sequential treatment regimen containing bismuth for Helicobacter pylori eradication in Turkish children. Helicobacter 2020; 25: e12757.
- Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017; 66: 6-30.
- Liu WZ, Xie Y, Lu H, et al. Fifth Chinese National Consensus Report on the management of Helicobacter pylori infection. Helicobacter 2018; 23: e12475.
- Burkitt MD, Duckworth CA, Williams JM, Pritchard DM. Helicobacter pylori-induced gastric pathology: insights from in vivo and ex vivo models. Dis Model Mech 2017; 10: 89-104.
- Hojo M, Nagahara A, Kudo T, et al. Endoscopic findings of Helicobacter pylori gastritis in children and young adults based on the Kyoto classification of gastritis and age-associated changes. JGH Open 2021; 5: 1197-1202.
- Keller J, Hammer HF, Afolabi PR, et al. European guideline on indications, performance and clinical impact of 13 C-breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC. United European Gastroenterol J 2021; 9: 598-625.
- Liu KS, Hung IF, Seto WK, et al. Ten day sequential versus 10 day modified bismuth quadruple therapy as empirical firstline and secondline treatment for Helicobacter pylori in Chinese patients: an open label, randomised, crossover trial. Gut 2014; 63: 1410-15.
- Liou JM, Chen CC, Chen MJ, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2013; 381: 205-13.
- Lee JY, Kim N, Park KS, et al. Comparison of sequential therapy and amoxicillin/tetracycline containing bismuth quadruple therapy for the first-line eradication of Helicobacter pylori: a prospective, multi-center, randomized clinical trial. BMC Gastroenterol 2016; 16: 79.
- Chen Y, Liu Q, Hu F, Ma J. Identifying the best regimen for primary eradication of Helicobacter pylori: analysis of 240 cases. Microbiologyopen 2021; 10: e1223.
- Zhou Y, Ye Z, Wang Y, et al. Comparison of four different regimens against Helicobacter pylori as a first-line treatment: A prospective, cross-sectional, comparative, open trial in Chinese children. Helicobacter 2020; 25: e12679.
- Szajewska H, Horvath A, Piwowarczyk A. Meta-analysis: the effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther 2010; 32: 1069-79.
- Zhou BG, Chen LX, Li B, Wan LY, Ai YW. Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis. Helicobacter 2019; 24: e12651.
- Bin Z, Ya-Zheng X, Zhao-Hui D, Bo C, Li-Rong J, Vandenplas Y. The efficacy of Saccharomyces boulardii CNCM I-745 in addition to standard Helicobacter pylori eradication treatment in children. Pediatr Gastroenterol Hepatol Nutr 2015; 18: 17-22.
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