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Efficacy and Safety of Saccharomyces Boulardii with Standard Quadruple Therapy for Eradication of Helicobacter Pylori in Adults: Meta-Analysis.

  • 2025-11-01
  • Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 35(11)
    • Fengzhen Ma
    • Heyin Huang
    • Kanglin Tian
    • Wei Wang

Study Design

Type
Meta-Analysis
Sample size
n = 295
Population
2,295 patients
Methods
Comprehensive searches across PubMed, Embase, Cochrane Library, CNKI, WanFang Data, CBM, and Web of Science identified relevant randomised controlled trials (RCTs). Analysis of 11 RCTs
Helicobacter pylori is a class I carcinogen, strongly associated with gastric cancer, gastric ulcers, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Helicobacter pylori (H. pylori) infection necessitates effective eradication strategies. This study evaluated Saccharomyces boulardii (S. boulardii) as an adjunctive therapy to standard bismuth-containing quadruple therapy for H. pylori eradication. Comprehensive searches across PubMed, Embase, Cochrane Library, CNKI, WanFang Data, CBM, and Web of Science identified relevant randomised controlled trials (RCTs). Analysis of 11 RCTs (n = 2,295 patients) demonstrated significantly higher eradication rates (78.6% to 89.2%) with adjunctive S. boulardii (n = 2,295; ITT analysis: RR = 1.12; 95% CI: 1.06-1.18; Z = 4.27, p <0.01) versus standard therapy alone. Crucially, the probiotic combination also substantially reduced treatment-related adverse events (n = 2,183; RR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002), with pronounced reductions in diarrhoea (n = 2,091; RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03) and rash occurrence (n = 1,271; RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01). These findings support S. boulardii supplementation as an effective strategy that enhances standard bismuth quadruple therapy efficacy while mitigating gastrointestinal and dermatological complications in H. pylori management. Therefore, the combination of S. boulardii and bismuth-containing quadruple therapy was effective in the treatment of H. pylori infection and has shown significant efficacy and safety as an effective and safe treatment. Key Words: Saccharomyces boulardii, Helicobacter pylori, Bismuth, Quadruple therapy.

Research Insights

  • saccharomyces boulardii→Increased Helicobacter pylori Eradication Rate

    Analysis of 11 RCTs (n = 2,295 patients) demonstrated significantly higher eradication rates (78.6% to 89.2%) with adjunctive S. boulardii (n = 2,295; ITT analysis: RR = 1.12; 95% CI: 1.06-1.18; Z = 4.27, p <0.01) versus standard therapy alone.

    Effect
    Beneficial
    Effect size
    Small

Adverse Events Reported

  • saccharomyces boulardii→diarrhoea

    pronounced reductions in diarrhoea (n = 2,091; RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03)

    Finding
    Reported
    Magnitude
    RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03
    Significant
    Yes
  • saccharomyces boulardii→rash

    and rash occurrence (n = 1,271; RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01)

    Finding
    Reported
    Magnitude
    RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01
    Significant
    Yes
  • saccharomyces boulardii→treatment-related adverse events

    the probiotic combination also substantially reduced treatment-related adverse events (n = 2,183; RR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002)

    Finding
    Reported
    Magnitude
    RR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002
    Significant
    Yes
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