P-157. Efficacy and Safety of Helicobacter pylori Triple Therapy With and Without Saccharomyces boulardii Supplementation: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

TL;DR

Adding Saccharomyces boulardii to standard H. pylori treatment improves eradication rates and reduces side effects like diarrhea and vomiting.

Contribution

A meta-analysis showing that S. boulardii supplementation improves H. pylori eradication and reduces adverse events in triple therapy.

Findings

S. boulardii supplementation increased H. pylori eradication rates in intention-to-treat and per-protocol analyses.

Supplementation reduced adverse events including diarrhea, vomiting, taste distortion, and abdominal distension.

Findings suggest S. boulardii could be a beneficial adjunct to standard triple therapy for H. pylori.

Abstract

The eradication of Helicobacter pylori (H. pylori) remains a significant challenge due to increasing antimicrobial resistance. Saccharomyces boulardii (S. boulardii), a probiotic with anti-inflammatory and antimicrobial properties, has been proposed as a beneficial adjunct for H. pylori eradication. This meta-analysis evaluates the efficacy of S. boulardii supplementation to triple therapy in enhancing H. pylori eradication rates and reducing adverse events.Figure 1.Forest plot of H. pylori eradication (ITT). CI, confidence interval; M–H, Mantel–Haenszel.

Forest plot of H. pylori eradication (ITT). CI, confidence interval; M–H, Mantel–Haenszel.

We systematically searched PubMed, Embase, Cochrane Central, Web of Science (WOS), and Scopus databases from inception until March 2025. We included randomized controlled trials (RCTs) comparing individuals receiving S. boulardii supplementation alongside triple therapy versus triple therapy alone for H. pylori eradication. Statistical analyses were performed using Review Manager 5.4.

Thirteen RCTs encompassing 2,349 patients from diverse demographic backgrounds were included. Patients receiving S. boulardii as an adjunct demonstrated significantly higher H. pylori eradication rates compared to those on triple therapy alone (ITT analysis: RR 1.13, 95% CI [1.08, 1.19], p < 0.00001; PP analysis: RR 1.07, 95% CI [1.02, 1.11], p = 0.002). Additionally, S. boulardii supplementation significantly reduced the incidence of vomiting (RR 0.24, 95% CI [0.06, 0.98], p = 0.05), diarrhea (RR 0.40, 95% CI [0.32, 0.50], p < 0.00001), taste distortion (RR 0.72, 95% CI [0.55, 0.93], p = 0.01), abdominal distension (RR 0.67, 95% CI [0.48, 0.93], p = 0.02), and abdominal pain (RR: 0.53, 95% CI 0.36 – 0.79, P = 0.002).

S. boulardii supplementation enhanced H. pylori eradication rates. Its addition to triple therapy reduced the incidence of diarrhea, vomiting, taste distortion, and abdominal distension compared to triple therapy alone. Further large-scale, multicenter trials are warranted to validate these results.

All Authors: No reported disclosures

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