Role of Probiotics in Managing of Helicobacter Pylori Infection: A Review

Abstract

Background: Helicobacter pylori is a prevalent pathogen which is considered as an etiological cause for gastroduodenal ulcers, and a substantial risk factor for gastric malignancies. The vital factor to take into account is that roughly half of the world’s population is infected with this bacterium. However, most subjects colonized remain asymptomatic and do not require any treatment. Several antimicrobial agents such as amoxicillin, clarithromycin and metronidazole are used to eradicate the infection. However, these drug regiments do not eradicate H. pylori in all patients because of the anti-drug resistance.

Aim: In this review we aim to discuss the role and mechanisms of probiotics, as supportive medicines, in management of H. pylori infection.

Methods: We have reviewed the published articles in PubMed and Medline databases. Also, abstracts presented in international conferences on the management of H. pylori infections and treatment protocol, have been thoroughly reviewed.

Results: The overall trend in the literature indicates the usefulness of probiotics in controlling H. pylori infection. This bacterium is among the most studied human pathogens regarding the efficacy of probiotics for treating its infection. Nevertheless, some studies suggest that probiotics do not efficiently eradicate H. pylori but retain the number of this bacterium at low levels inside the human stomach.

Conclusion: The analyzed literature suggest that when probiotics are consumed in conjunction with antibiotics, the eradication rate may be improved through modulating the immune response and decreasing the adverse effects of routine drugs leading to gastroprotection.

Key words

Helicobacter pylori - probiotics - gastroprotection - immune response

• References

• 1 Marshall B, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. The Lancet 1984; 323: 1311-1315
• 2 Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clinical microbiology reviews 2006; 19: 449-490
• 3 Ghotaslou R, Milani M, Akhi MT et al. Diversity of Helicobacter pylori cagA and vacA genes and its relationship with clinical outcomes in Azerbaijan, Iran. Adv Pharm Bull 2013; 3: 57-62
• 4 Lee JH, Jun SH, Kim JM et al. Morphological changes in human gastric epithelial cells induced by nuclear targeting of Helicobacter pylori urease subunit A. Journal of Microbiology 2015; 53: 406-414
• 5 Dadashzadeh K, Milani M, Rahmati M et al. Real-Time PCR detection of 16S rRNA novel mutations associated with Helicobacter pylori tetracycline resistance in Iran. Asian Pac J Cancer Prev 2014; 15: 8883-8886
• 6 Hellmig S, Ott S, Rosenstiel P et al. Genetic variants in matrix metalloproteinase genes are associated with development of gastric ulcer in H. pylori infection. The American journal of gastroenterology 2006; 101: 29-35
• 7 Lehours P, Zheng Z, Skoglund A et al. Is there a link between the lipopolysaccharide of Helicobacter pylori gastric MALT lymphoma associated strains and lymphoma pathogenesis?. PLoS One 2009; 4: e7297
• 8 Uemura N, Okamoto S, Yamamoto S et al. Helicobacter pylori infection and the development of gastric cancer. New England Journal of Medicine 2001; 345: 784-789
• 9 Salihefendic N, Zildzic M, Cabric E. A New Approach to the Management of Uninvestigated Dyspepsia in Primary Care. Medical Archives 2015; 69: 133
• 10 Yeomans ND. The ulcer sleuths: The search for the cause of peptic ulcers. Journal of gastroenterology and hepatology 2011; 26 (Suppl. 01) 35-41
• 11 Dixon MF. IV. Helicobacter pylori and peptic ulceration: Histopathological aspects. Journal of gastroenterology and hepatology 1991; 6: 125-130
• 12 Ierardi E, Giorgio F, Losurdo G et al. How antibiotic resistances could change Helicobacter pylori treatment: A matter of geography. World J Gastroenterol 2013; 19: 8168-8180
• 13 Mégraud F, Lamouliatte H. Helicobacter pylori and duodenal ulcer. Digestive diseases and sciences 1992; 37: 769-772
• 14 Gong Y, Li Y, Sun Q. Probiotics improve efficacy and tolerability of triple therapy to eradicate Helicobacter pylori: a meta-analysis of randomized controlled trials. International journal of clinical and experimental medicine 2015; 8: 6530
• 15 Richter J. H pylori: the bug is not all bad. Gut 2001; 49: 319-320
• 16 Dunn BE, Campbell GP, Perez-Perez GI et al. Purification and characterization of urease from Helicobacter pylori. Journal of Biological Chemistry 1990; 265: 9464-9469
• 17 Yamaoka Y, Kodama T, Kita M et al. Relation between clinical presentation, Helicobacter pylori density, interleukin 1β and 8 production, and cagA status. Gut 1999; 45: 804-811
• 18 Tokunaga Y, Shirahase H, Hoppou T et al. Density of Helicobacter pylori infection evaluated semiquantitatively in gastric cancer. Journal of clinical gastroenterology 2000; 31: 217-221
• 19 Yazbek PB, Trindade AB, Chin CM et al. Challenges to the treatment and new perspectives for the eradication of helicobacter pylori. Digestive diseases and sciences 2015; 60: 2901-2912
• 20 Miftahussurur M, Yamaoka Y. Appropriate first-line regimens to combat Helicobacter pylori antibiotic resistance: an Asian perspective. Molecules 2015; 20: 6068-6092
• 21 Isolauri E, Kirjavainen P, Salminen S. Probiotics: a role in the treatment of intestinal infection and inflammation?. Gut 2002; 50 (Suppl. 03) iii54-iii59
• 22 Marteau P, Seksik P, Jian R. Probiotics and intestinal health effects: a clinical perspective. British Journal of Nutrition 2002; 88 (Suppl. 01) s51-s57
• 23 Hamilton-Miller J. The role of probiotics in the treatment and prevention of Helicobacter pylori infection. International journal of antimicrobial agents 2003; 22: 360-366
• 24 Qua CS, Manikam J, Goh KL. Efficacy of 1-week proton pump inhibitor triple therapy as first-line Helicobacter pylori eradication regime in Asian patients: Is it still effective 10 years on?. Journal of digestive diseases 2010; 11: 244-248
• 25 Kuo C-H, Kuo FC, Hu HM et al. The optimal first-line therapy of Helicobacter pylori infection in year 2012. Gastroenterol Res pract 2012; 2012 168361.
• 26 Megraud F. Helicobacter pylori and antibiotic resistance. Gut 2007; 56: 1502
• 27 Pacifico L, Osborn JF, Bonci E et al. Probiotics for the treatment of Helicobacter pylori infection in children. World J Gastroenterol 2014; 20: 673-683
• 28 Rijkers GT, de Vos WM, Brummer RJ et al. Health benefits and health claims of probiotics: bridging science and marketing. British Journal of Nutrition 2011; 106: 1291-1296
• 29 Azizpour K, Bahrambeygi S, Mahmoodpour S et al. History and basic of probiotics. Research Journal of Biological Sciences 2009; 4: 409-426
• 30 Metschnikoff E, Chalmers P. The prolongation of life. Optimistic studies. London, UK: William Heinemann; 1907
• 31 Sonomoto K, Yokota A. Lactic acid bacteria and bifidobacteria: current progress in advanced research. Horizon Scientific Press; 2011
• 32 Tannock GW. Probiotics and prebiotics: scientific aspects. Horizon Scientific Press; 2005
• 33 Heller KJ. Probiotic bacteria in fermented foods: product characteristics and starter organisms. The American Journal of Clinical Nutrition 2001; 73: 374s-379s
• 34 Suresh K, Krishnappa S, Bhardwaj P. Safety concerns of Probiotic use: A review. Safety 2013; 34: 40
• 35 Rijkers GT, Bengmark S, Enck P et al. Guidance for substantiating the evidence for beneficial effects of probiotics: current status and recommendations for future research. The Journal of nutrition 2010; 140: 671S-676S
• 36 Rochet V, Rigottier-Gois L, Levenez F et al. Modulation of Lactobacillus casei in ileal and fecal samples from healthy volunteers after consumption of a fermented milk containing Lactobacillus casei DN-114 001Rif. Canadian journal of microbiology 2008; 54: 660-667
• 37 Rochet V, Rigottier-Gois L, Ledaire A et al. Survival of Bifidobacterium animalis DN-173 010 in the faecal microbiota after administration in lyophilised form or in fermented product – a randomised study in healthy adults. Journal of molecular microbiology and biotechnology 2007; 14: 128-136
• 38 Tuohy K, Pinart-Gilberga M, Jones M et al. Survivability of a probiotic Lactobacillus casei in the gastrointestinal tract of healthy human volunteers and its impact on the faecal microflora. Journal of applied microbiology 2007; 102: 1026-1032
• 39 Elli M, Callegari ML, Ferrari S et al. Survival of yogurt bacteria in the human gut. Applied and environmental microbiology 2006; 72: 5113-5117
• 40 Bezkorovainy A. Probiotics: determinants of survival and growth in the gut. The American journal of clinical nutrition 2001; 73: 399s-405s
• 41 Mättö J, Fondénb R, Tolvanen T et al. Intestinal survival and persistence of probiotic Lactobacillus and Bifidobacterium strains administered in triple-strain yoghurt. International dairy journal 2006; 16: 1174-1180
• 42 Johansson M-L, Nobaek S, Berggren A et al. Survival of Lactobacillus plantarum DSM 9843 (299v), and effect on the short-chain fatty acid content of faeces after ingestion of a rose-hip drink with fermented oats. International journal of food microbiology 1998; 42: 29-38
• 43 Goldin BR, Gorbach SL, Saxelin M et al. Survival ofLactobacillus species (strain GG) in human gastrointestinal tract. Digestive diseases and sciences 1992; 37: 121-128
• 44 Fuller R, Gibson GR. Probiotics and prebiotics: microflora management for improved gut health. Clinical microbiology and infection 1998; 4: 477-480
• 45 Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health. The Journal of nutrition 2000; 130: 396S-402S
• 46 Avía Y, Suzuki N, Kabir AM et al. Lactic acidmediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol 1998; 93: 2097-2101
• 47 Sgouras D, Maragkoudakis P, Petraki K et al. In vitro and in vivo inhibition of Helicobacter pylori by Lactobacillus casei strain Shirota. Applied and environmental microbiology 2004; 70: 518-526
• 48 Cats A, Kuipers EJ, Bosschaert MA et al. Effect of frequent consumption of a Lactobacillus casei-containing milk drink in Helicobacter pylori-colonized subjects. Alimentary pharmacology & therapeutics 2003; 17: 429-435
• 49 Linsalata M, Russo F, Berloco P et al. The influence of lactobacillus brevis on ornithine decarboxylase activity and polyamine profiles in helicobacter pylori-infected gastric mucosa. Helicobacter 2004; 9: 165-172
• 50 Pantoflickova D, Corthésy-Theulaz I, Dorta G et al. Favourable effect of regular intake of fermented milk containing Lactobacillus johnsonii on Helicobacter pylori associated gastritis. Alimentary pharmacology & therapeutics 2003; 18: 805-813
• 51 Ruggiero P. Use of probiotics in the fight against Helicobacter pylori. World J Gastrointest Pathophysiol 2014; 5: 384-391
• 52 Gotteland M, Brunser O, Cruchet S. Systematic review: are probiotics useful in controlling gastric colonization by Helicobacter pylori?. Alimentary pharmacology & therapeutics 2006; 23: 1077-1086
• 53 Sartor RB. Probiotic therapy of intestinal inflammation and infections. Current opinion in gastroenterology 2005; 21: 44-50
• 54 Salminen S, Isolauri E, Salminen E. Clinical uses of probiotics for stabilizing the gut mucosal barrier: successful strains and future challenges. Antonie Van Leeuwenhoek 1996; 70: 347-358
• 55 Ling WH, Korpela R, Mykkänen H et al. Lactobacillus strain GG supplementation decreases colonic hydrolytic and reductive enzyme activities in healthy female adults. The Journal of nutrition 1994; 124: 18-23
• 56 Marteau P, Flourie B, Pochart P et al. Effect of the microbial lactase (EC 3.2. 1.23) activity in yoghurt on the intestinal absorption of lactose: an in vivo study in lactase-deficient humans. British Journal of Nutrition 1990; 64: 71-79
• 57 Michetti P, Dorta G, Wiesel PH et al. Effect of whey-based culture supernatant of Lactobacillus acidophilus (johnsonii) La1 on Helicobacter pylori infection in humans. Digestion 1999; 60: 203-209
• 58 Canducci F, Armuzzi A, Cremonini F et al. A lyophilized and inactivated culture of Lactobacillus acidophilus increases Helicobacter pylori eradication rates. Alimentary pharmacology & therapeutics 2000; 14: 1625-1629
• 59 Armuzzi A, Cremonini F, Ojetti V et al. Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Digestion 2001; 63: 1-7
• 60 Sheu BS, Wu JJ, Lo CY et al. Impact of supplement with Lactobacillus-and Bifidobacterium-containing yogurt on triple therapy for Helicobacter pylori eradication. Alimentary pharmacology & therapeutics 2002; 16: 1669-1675
• 61 Tursi A, Brandimarte G, Giorgetti GM et al. Effect of Lactobacillus casei supplementation on the effectiveness and tolerability of a new second-line 10-day quadruple therapy after failure of a first attempt to cure Helicobacter pylori infection. Medical Science Monitor 2004; 10: CR662-CR666
• 62 Armuzzi A, Cremonini F, Bartolozzi F et al. The effect of oral administration of Lactobacillus GG on antibiotic-associated gastrointestinal side-effects during Helicobacter pylori eradication therapy. Alimentary pharmacology & therapeutics 2001; 15: 163-169
• 63 Cremonini F, Di Caro S, Covino M et al. Effect of different probiotic preparations on anti-Helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. The American journal of gastroenterology 2002; 97: 2744-2749
• 64 Manfredi M, Bizzarri B, Sacchero RI et al. Helicobacter pylori infection in clinical practice: probiotics and a combination of probiotics+ lactoferrin improve compliance, but not eradication, in sequential therapy. Helicobacter 2012; 17: 254-263
• 65 Gisbert J, Khorrami S, Calvet X et al. Meta-analysis: proton pump inhibitors vs. H2-receptor antagonists – their efficacy with antibiotics in Helicobacter pylori eradication. Alimentary pharmacology & therapeutics 2003; 18: 757-766
• 66 Myllyluoma E, Veijola L, Ahlroos T et al. Probiotic supplementation improves tolerance to Helicobacter pylori eradication therapy – a placebo-controlled, double-blind randomized pilot study. Alimentary pharmacology & therapeutics 2005; 21: 1263-1272
• 67 Ernst PB, Gold BD. The disease spectrum of Helicobacter pylori: the immunopathogenesis of gastroduodenal ulcer and gastric cancer. Annual Reviews in Microbiology 2000; 54: 615-640
• 68 Havenaar R, Ten Brink B, Huis JH. Selection of strains for probiotic use, in Probiotics. Springer; 1992: 209-224
• 69 Sartor RB. Enteric microflora in IBD: pathogens or commensals?. Inflammatory bowel diseases 1997; 3: 230-235
• 70 Wang K-Y, Li SN, Liu CS et al. Effects of ingesting Lactobacillus-and Bifidobacterium-containing yogurt in subjects with colonized Helicobacter pylori. The American journal of clinical nutrition 2004; 80: 737-741
• 71 Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics 2005; 115: 5-9
• 72 Malfertheiner P, Megraud F, O’Morain CA et al. Management of Helicobacter pylori infection – the Maastricht IV/Florence consensus report. Gut 2012; 61: 646-664
• 73 Lu C, Sang J, He H et al. Probiotic supplementation does not improve eradication rate of Helicobacter pylori infection compared to placebo based on standard therapy: a meta-analysis. Scientific reports 2016; 6: 1-10
• 74 Zhang M-M, Qian W, Qin YY et al. Probiotics in Helicobacter pylori eradication therapy: a systematic review and meta-analysis. World J Gastroenterol 2015; 21: 4345-4357