Effectiveness of Lactobacillus-supplemented eradication therapy for Helicobacter pylori: a systematic review and meta-analysis of randomized controlled trials

Abstract

PURPOSE: Helicobacter pylori eradication therapies supplemented with Lactobacillus spp. may improve eradication rates and reduce adverse events by modulating gut microbiota and immune responses. This meta-analysis aimed to evaluate the efficacy and safety of Lactobacillus-supplemented Helicobacter pylori eradication therapy. METHODS: We systematically searched for randomized controlled trials (RCTs) comparing standard Helicobacter pylori eradication therapy with and without Lactobacillus in PubMed, Embase, and Cochrane Library up to August 2026. The primary outcome was eradication success, and the secondary outcome was adverse events. We calculated pooled risk ratios (RR) with 95% confidence intervals (CIs) using a random-effects model. We also estimated the number needed to treat (NNT) for eradication success and conducted subgroup analyses by antibiotic therapy type, duration of antibiotic treatment, Lactobacillus strain type, Lactobacillus dosage, period of Lactobacillus use, probiotic formulation, geographical region, and age range. This review was registered in PROSPERO (CRD42024611138). RESULTS: Thirty-two RCTs (4,010 patients) were included. Lactobacillus-supplemented eradication therapy improved eradication success (RR 1.10; 95%CI 1.05-1.14; NNT 13) and reduced the risk of adverse events (RR 0.70; 95%CI 0.58-0.84). Subgroup analyses showed significant differences in eradication success by antibiotic regimen and in adverse event risk by age group. Improved eradication success with Lactobacillus-supplemented eradication therapy was observed only with triple therapy regimens, whereas adverse event risk was reduced only among adults. CONCLUSION: Lactobacillus-supplemented eradication therapy was associated with a 10% relative increase in Helicobacter pylori eradication success and a 30% relative reduction in treatment-related adverse events compared with the control group.