Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicobacter pylori eradication.

2025-04-18
BMC gastroenterology 25(1)
- Yi-Zhou Jiang
- Kai Ma
- Cheng Cui
- Zhuo-Ya Li
- Xiao-Yong Wang

PubMed: 40251486
DOI: 10.1186/s12876-025-03879-y

Study Design

Type: Meta-Analysis
Methods: Systematic literature search across PubMed, Embase, Web of Science, and China National Knowledge Infrastructure for articles published up to October 2023; calculated pooled relative risk with 95% confidence interval using Stata/SE 15.1 software.
Funding: Unclear

Background

Helicobacter pylori (H. pylori) infection is a common chronic infection, and there are over half of the global population infected with H. pylori. It is still controversial whether the supplementation of Saccharomyces boulardii (S. boulardii) to bismuth quadruple therapy is beneficial for H. pylori eradication.

Aim

To determine the effects of S. boulardii supplementation to bismuth quadruple therapy on H. pylori eradication.

Methods

We performed a systematic literature search across PubMed, Embase, Web of Science, and China National Knowledge Infrastructure for articles published up to October 2023. We calculated the pooled relative risk (RR) with the 95% confidence interval (CI). Statistical analyses were conducted using Stata/SE 15.1 software.

Results

Ten randomized controlled trials were included. Notably, S. boulardii supplementation to bismuth quadruple therapy significantly improved H. pylori eradication rates (RR = 1.08, 95% CI: 1.04-1.12) and reduced the incidence of total adverse effects (RR = 0.53, 95% CI: 0.45-0.62). Specifically, it reduced the incidence of some gastrointestinal adverse effects and nonspecific adverse effects, including diarrhea (RR = 0.28, 95% CI: 0.22-0.36), constipation (RR = 0.32, 95% CI: 0.18-0.55), abdominal distention (RR = 0.39, 95% CI: 0.26-0.59), nausea (RR = 0.59, 95% CI: 0.36-0.97), and rash (RR = 0.49, 95% CI: 0.28-0.86). In the subgroup analysis, long-term eradication duration (> 10 days; RR = 1.08, 95% CI: 1.04-1.13) and S. boulardii supplementation to be started and stopped at the same time as eradication treatment (RR = 1.09, 95% CI: 1.04-1.14) were found to significantly improve the eradication rate regardless of the S. boulardii dose (500 mg/day, RR = 1.10, 95% CI: 1.03-1.17; 1000 mg/day, RR = 1.08, 95% CI: 1.03-1.12).

Conclusions

The addition of S. boulardii to bismuth quadruple therapy significantly increased H. pylori eradication rates and decreased the adverse effects. We recommend adding 500 mg/day S. boulardii concurrently with bismuth quadruple therapy and continuing this therapy for > 10 days for optimal H. pylori eradication efficacy.

Research Insights

saccharomyces boulardii→Increased Helicobacter pylori Eradication Rate
S. boulardii supplementation to be started and stopped at the same time as eradication treatment (RR = 1.09, 95% CI: 1.04-1.14)
Effect
Beneficial
Effect size
Small
Dose
500 mg/day or 1000 mg/day
saccharomyces boulardii→Reduced Abdominal Distension
abdominal distention (RR = 0.39, 95% CI: 0.26-0.59)
Effect
Beneficial
Effect size
Large
Dose
500 mg/day or 1000 mg/day
saccharomyces boulardii→Reduced Diarrhea Rate
diarrhea (RR = 0.28, 95% CI: 0.22-0.36)
Effect
Beneficial
Effect size
Large
Dose
500 mg/day or 1000 mg/day
saccharomyces boulardii→Reduced Incidence of Constipation
constipation (RR = 0.32, 95% CI: 0.18-0.55)
Effect
Beneficial
Effect size
Large
Dose
500 mg/day or 1000 mg/day
saccharomyces boulardii→Reduced Incidence of Total Adverse Effects
reduced the incidence of total adverse effects (RR = 0.53, 95% CI: 0.45-0.62)
Effect
Beneficial
Effect size
Moderate
Dose
500 mg/day or 1000 mg/day
saccharomyces boulardii→Reduced Nausea Incidence
nausea (RR = 0.59, 95% CI: 0.36-0.97)
Effect
Beneficial
Effect size
Moderate
Dose
500 mg/day or 1000 mg/day
saccharomyces boulardii→Reduced Rash Incidence
rash (RR = 0.49, 95% CI: 0.28-0.86)
Effect
Beneficial
Effect size
Moderate
Dose
500 mg/day or 1000 mg/day

Adverse Events Reported

saccharomyces boulardii→abdominal distention
abdominal distention (RR = 0.39, 95% CI: 0.26-0.59)
Finding
Increased risk
Magnitude
RR = 0.39, 95% CI: 0.26-0.59
Significant
Yes
saccharomyces boulardii→constipation
constipation (RR = 0.32, 95% CI: 0.18-0.55)
Finding
Increased risk
Magnitude
RR = 0.32, 95% CI: 0.18-0.55
Significant
Yes
saccharomyces boulardii→diarrhea
Specifically, it reduced the incidence of some gastrointestinal adverse effects and nonspecific adverse effects, including diarrhea (RR = 0.28, 95% CI: 0.22-0.36)
Finding
Increased risk
Magnitude
RR = 0.28, 95% CI: 0.22-0.36
Significant
Yes
saccharomyces boulardii→nausea
nausea (RR = 0.59, 95% CI: 0.36-0.97)
Finding
Increased risk
Magnitude
RR = 0.59, 95% CI: 0.36-0.97
Significant
Yes
saccharomyces boulardii→rash
rash (RR = 0.49, 95% CI: 0.28-0.86)
Finding
Increased risk
Magnitude
RR = 0.49, 95% CI: 0.28-0.86
Significant
Yes
saccharomyces boulardii→Overall tolerability
S. boulardii supplementation to bismuth quadruple therapy significantly improved H. pylori eradication rates (RR = 1.08, 95% CI: 1.04-1.12) and reduced the incidence of total adverse effects (RR = 0.53, 95% CI: 0.45-0.62).
Finding
Reported