AUTHOR=Chen Yin , Teng Tao , Su Yu , Chen Wen-Zhong 

TITLE=The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for eradicating Helicobacter pylori: a systematic review and meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1344702

DOI=10.3389/fmed.2024.1344702

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background and objective</title><p>It remains uncertain if the addition of <italic>Saccharomyces boulardii</italic> (<italic>S. boulardii</italic>) to bismuth quadruple therapy (BQT) recommended in the current guidelines can enhance the <italic>Helicobacter pylori</italic> (<italic>H. pylori</italic>) eradication rate and decrease the incidence of adverse events. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to address this issue.</p></sec><sec id="sec2"><title>Methods</title><p>We performed comprehensive searches in PubMed, Embase, Web of Science, and Cochrane library databases from the inception of the databases through to November 1, 2023. A meta-analysis was conducted to determine the pooled relative risk (RR) with 95% confidence intervals (CI) using a random-effects model. We utilized the revised Cochrane Risk of Bias Tool to assess the risk of bias of included studies.</p></sec><sec id="sec3"><title>Results</title><p>A total of six RCTs (1,404 patients) included in this meta-analysis. The results of the intention-to-treat analysis showed that the combination of <italic>S. boulardii</italic> with BQT had a higher eradication rate than BQT alone (87.0% versus 83.3%), with a pooled RR of 1.05 (95% CI: 1.00–1.10, <italic>p</italic> = 0.03). In the per-protocol analysis, however, there was no statistical significance between the two groups in the eradication rate (93.7% versus 91.0%, RR = 1.03, 95% CI: 1.00–1.06, <italic>p</italic> = 0.07). The combination of <italic>S. boulardii</italic> and BQT had a significantly lower rate of overall adverse events (22% vs. 39%, RR = 0.56, 95% CI: 0.44–0.70, <italic>p</italic> &lt; 0.00001), diarrhea (7.9% vs. 25.7%, RR = 0.29, 95% CI: 0.17–0.48, <italic>p</italic> &lt; 0.00001), constipation (2.9% vs. 8.4%, RR = 0.35, 95% CI: 0.14–0.88, <italic>p</italic> = 0.03) and abdominal distention (4.9% vs. 12.7%, RR = 0.41, 95% CI: 0.23–0.72, <italic>p</italic> = 0.002) than BQT alone. For the assessment of risk of bias, five studies were deemed to have some concerns, while one study was judged to have a low risk.</p></sec><sec id="sec4"><title>Conclusion</title><p>Current evidence suggests that supplementation with <italic>S. boulardii</italic> in BQT may not have a major effect on the <italic>H. pylori</italic> eradication rate, but significantly reduces the incidence of overall adverse events, diarrhea, abdominal distention and constipation. Combining <italic>S. Boulardii</italic> with BQT can help alleviate symptoms, potentially improving patient adherence.</p></sec><sec id="sec5"><title>Systematic review registration</title><p>https://osf.io/n9z7c.</p></sec>