Lactobacillus supplementation for Helicobacter pylori eradication in children: A language-inclusive systematic review and meta-analysis of efficacy and safety.

BACKGROUND

Increasing antibiotic resistance has reduced the effectiveness of standard Helicobacter pylori (H. pylori) eradication therapies in children. Probiotics, particularly Lactobacillus species, have been proposed as adjuvants to improve treatment outcomes and reduce side effects.

AIM: To evaluate the efficacy and safety of Lactobacillus spp. alongside standard eradication therapy in pediatric populations, emphasizing globally representative evidence through inclusion of non-English studies, especially from high-prevalence regions such as China.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed/MEDLINE, Cochrane CENTRAL, Scopus, and four Chinese databases. Primary outcome was eradication rate; secondary outcomes included overall and specific adverse events (AEs). Subgroup analyses evaluated probiotic dosage, supplementation duration, and eradication regimen.

RESULTS

Thirteen RCTs involving 1428 children were included; eight were conducted in China. Lactobacillus spp. significantly improved eradication rates [89.7% vs 72.3%; relative risk (RR) = 1.24, 95% confidence interval (CI): 1.15-1.34, I 2 = 45%]. The effect was most pronounced in triple therapy (RR = 1.28, 95%CI: 1.17-1.40) and with higher probiotic doses (≥ 5 × 109 colony-forming units/day; RR = 1.36, 95%CI: 1.15-1.60). Lactobacillus spp. also significantly reduced overall AEs (RR = 0.50, 95%CI: 0.30-0.84), particularly diarrhea (RR = 0.49, 95%CI: 0.27-0.92), nausea/vomiting (RR = 0.66, 95%CI: 0.45-0.95), and taste disturbances (RR = 0.42, 95%CI: 0.23-0.76).

CONCLUSION

Adjunctive Lactobacillus therapy significantly enhances H. pylori eradication rates and reduces treatment-related adverse effects in children. Its benefits are dose-dependent and most evident in triple therapy regimens. Inclusion of Chinese and other non-English studies provides the most geographically comprehensive evidence to date, supporting the use of Lactobacillus probiotics as a complementary strategy to optimize H. pylori management in pediatric patients across diverse global settings.