European Journal of Pediatrics

, Volume 178, Issue 1, pp 7–16 | Cite as

Efficacy of Lactobacillus-supplemented triple therapy for Helicobacter pylori infection in children: a meta-analysis of randomized controlled trials

  • Hao-Ran Fang
  • Guo-Qiang Zhang
  • Jing-Yi Cheng
  • Zhong-Yue LiEmail author


Therapy-related side effects and severe antimicrobial resistance still remain an obstacle to Helicobacter pylori eradication. This meta-analysis aimed to investigate the efficacy of Lactobacillus-supplemented triple therapy on H. pylori eradication rates and therapy-related side effects in children. Five studies involving 484 pediatric patients were included in our analysis. The pooled relative risk (RR) for eradication rates in the Lactobacillus group versus the control group was 1.19 [95% confidence interval (CI) 1.07–1.33]. In subgroup analyses based on dose and duration of Lactobacillus supplementation, the pooled RRs for eradication rates were 1.36 (95% CI 1.15–1.60) in the high-dose group, 1.08 (95% CI 0.86–1.35) in the low-dose group, 1.24 (95% CI 1.06–1.46) in the long-term group, and 1.17 (95% CI 0.96–1.44) in the short-term group. With respect to side effects, Lactobacillus supplementation significantly reduced the incidence of diarrhea (RR = 0.30, 95% CI 0.10–0.85).

Conclusions: Lactobacillus, as an adjunct to triple therapy, can increase H. pylori eradication rates as well as reduce the incidence of therapy-related diarrhea in children. And a higher dose and a longer duration of supplementation may conduce to the positive impact of Lactobacillus on H. pylori eradication.

What is Known:

Probiotics-supplemented triple therapy may be beneficial in improving H. pylori eradication rates and reducing therapy-related side effects in children. However, not all probiotics are beneficial to H. pylori eradication and the pooled outcomes based on different probiotics may be erroneously extrapolated to other ineffective strains.

What is New:

Lactobacillus, as an adjunct to triple therapy, can increase H. pylori eradication rates as well as reduce the incidence of therapy-related diarrhea in children.


Lactobacillus Triple therapy H. pylori Children Meta-analysis 



Colony-forming unit


Confidence interval


H. pylori stool antigen test


Nonsteroidal anti-inflammatory drug


Randomized controlled trial


Relative risk


Rapid urease test


Proton pump inhibitor


Urea breath test


Authors’ contributions

H-RF: study design, search and selection of articles, data extraction, statistical analysis, drafting the manuscript; G-QZ: data extraction, quality assessment, statistical analysis, revising the manuscript; J-YC: search and selection of articles, quality assessment, statistical analysis; Z-YL: study design, statistical analysis, drafting, and revising the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable for this manuscript.

Informed consent

Not applicable for this manuscript.

Supplementary material

431_2018_3282_MOESM1_ESM.doc (19 kb)
Table S1 (DOC 18 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology, Ministry of Eduaction Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and DisordersChildren’s Hospital of Chongqing Medical UniversityChongqingChina
  2. 2.Department of Child Health CareChildren’s Hospital of Chongqing Medical UniversityChongqingChina

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