Multistrain probiotics alleviate gastrointestinal symptoms during bismuth quadruple therapy for Helicobacter pylori infection.

BACKGROUND

Bismuth quadruple therapy (BQT) induces troublesome gastrointestinal side effects that reduce adherence and efficacy.

AIM: To evaluate multistrain probiotics efficacy for alleviating gastrointestinal symptoms during BQT for Helicobacter pylori (H. pylori) eradication.

METHODS

One hundred seventy-four adults (18-60 years) with confirmed H. pylori infections between July 2022 and December 2023 were randomised to receive BQT plus a multispecies probiotic (n = 89) or a maltodextrin placebo (n = 85) for 4 weeks. Gastrointestinal Symptom Rating Scale (GSRS) and Bristol Stool Classification Scale scores were collected at baseline, 2, 4 and 8 weeks; eradication was assessed 8 weeks post-treatment. Intention-to-treat analysis used multiple imputation and SPSS 26.0.

RESULTS

After 8 weeks, GSRS scores (all dimensions and total) decreased significantly compared with those at baseline. ITT analysis showed significantly greater reductions for the intervention vs the placebo in reflux by week 2, total/diarrhea scores by week 4, and total/dyspepsia scores by week 8. Probiotics provided no protective effect against gastrointestinal symptoms at week 2 but showed significant protection at weeks 4 and 8. Both groups reported decreased diarrhea/constipation-type stools and increased normal-type stools post-intervention. H. pylori eradication rates were slightly higher for the intervention group (88.8%) than for the placebo group (84.7%), but the difference was not significant (P = 0.430).

CONCLUSION

Multistrain probiotics significantly relieved BQT-associated gastrointestinal symptoms without affecting eradication success.