Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication of Helicobacter pylori: a meta-analysis.

2025-02-12
Frontiers in cellular and infection microbiology 15
- Manning Li
- Ying Xie

PubMed: 40012609
DOI: 10.3389/fcimb.2025.1441185

Study Design

Type: Meta-Analysis
Population: patients with Helicobacter pylori infection
Methods: systematic review and meta-analysis of 19 studies with 5,036 cases; searched PubMed and Web of Science from January 2002 to January 2023; addition of Saccharomyces boulardii to traditional therapy

Background

Helicobacter pylori (H. pylori) is highly prevalent worldwide and is closely associated with many gastric conditions. Current methods for eradicating H. pylori include triple or quadruple therapy, including antibiotics, proton pump inhibitors, and bismuth agents; however, with antibiotic abuse and increased drug resistance rates, the effectiveness of traditional methods is gradually decreasing, with many adverse effects such as abdominal pain, diarrhea, and intolerance. In recent years, there has been controversy regarding whether adding Saccharomyces boulardii (S. boulardii) to traditional therapies is beneficial for eradicating H. pylori.

Aim

To evaluate the efficacy and safety of S. boulardii as an adjuvant therapy for the eradication of H. pylori.

Methods

We systematically searched the PubMed and Web of Science databases from January 2002 to January 2023. The primary outcome was the H. pylori eradication rate. The secondary outcomes included total adverse effects, abdominal pain, diarrhea, bloating, constipation, nausea, vomiting, taste disorders, and other adverse reactions. We evaluated the included studies for publication bias and heterogeneity. Fixed- and random-effects models were used for studies without and with heterogeneity, respectively, to calculate the risk ratios (RRs) and conduct sensitivity and subgroup analyses.

Results

Nineteen studies comprising 5,036 cases of H. pylori infection were included in this meta-analysis. The addition of S. boulardii to traditional therapy significantly improved the H. pylori eradication rate [RR=1.11, 95% confidence interval (CI): 1.08-1.15] and reduced the incidence of total adverse effects (RR=0.49, 95% CI: 0.37-0.66), diarrhea (RR=0.36, 95% CI: 0.26-0.48), abdominal distension (RR=0.49, 95% CI: 0.33-0.72), constipation (RR=0.38, 95% CI: 0.26-0.57), and nausea (RR=0.50, 95% CI: 0.37-0.68). However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.

Conclusions

S. boulardii supplementation in traditional eradication therapy significantly improves the H. pylori eradication rate and reduces the total adverse effects and incidence of diarrhea, bloating, constipation, and nausea.

Systematic review registration

Prospero, identifier CRD42024549780.

Research Insights

saccharomyces boulardii→Improved H Pylori Eradication Rates
The addition of S. boulardii to traditional therapy significantly improved the H. pylori eradication rate [RR=1.11, 95% confidence interval (CI): 1.08-1.15]
Effect
Beneficial
Effect size
Small
saccharomyces boulardii→Reduced Abdominal Distension
reduced the incidence of ... abdominal distension (RR=0.49, 95% CI: 0.33-0.72)
Effect
Beneficial
Effect size
Moderate
saccharomyces boulardii→Reduced Abdominal Pain
it did not reduce the occurrence of abdominal pain
Effect
Neutral
Effect size
Small
saccharomyces boulardii→Reduced Adverse Effects
reduced the incidence of total adverse effects (RR=0.49, 95% CI: 0.37-0.66)
Effect
Beneficial
Effect size
Moderate
saccharomyces boulardii→Reduced Constipation
reduced the incidence of ... constipation (RR=0.38, 95% CI: 0.26-0.57)
Effect
Beneficial
Effect size
Large
saccharomyces boulardii→Reduced Diarrhea
reduced the incidence of ... diarrhea (RR=0.36, 95% CI: 0.26-0.48)
Effect
Beneficial
Effect size
Large
saccharomyces boulardii→Reduced Nausea
reduced the incidence of ... nausea (RR=0.50, 95% CI: 0.37-0.68)
Effect
Beneficial
Effect size
Moderate
saccharomyces boulardii→Reduced Taste Disorder
it did not reduce the occurrence of ... taste disorders
Effect
Neutral
Effect size
Small
saccharomyces boulardii→Reduced Vomiting
it did not reduce the occurrence of ... vomiting
Effect
Neutral
Effect size
Small

Adverse Events Reported

saccharomyces boulardii→Overall tolerability
The addition of S. boulardii to traditional therapy significantly improved the H. pylori eradication rate [RR=1.11, 95% confidence interval (CI): 1.08-1.15] and reduced the incidence of total adverse effects (RR=0.49, 95% CI: 0.37-0.66)
Finding
No significant difference
saccharomyces boulardii→abdominal distension
abdominal distension (RR=0.49, 95% CI: 0.33-0.72)
Finding
No significant difference
Magnitude
RR=0.49, 95% CI: 0.33-0.72
Significant
Yes
saccharomyces boulardii→abdominal pain
However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.
Finding
No significant difference
Significant
No
saccharomyces boulardii→constipation
constipation (RR=0.38, 95% CI: 0.26-0.57)
Finding
No significant difference
Magnitude
RR=0.38, 95% CI: 0.26-0.57
Significant
Yes
saccharomyces boulardii→diarrhea
reduced the incidence of total adverse effects (RR=0.49, 95% CI: 0.37-0.66), diarrhea (RR=0.36, 95% CI: 0.26-0.48)
Finding
No significant difference
Magnitude
RR=0.36, 95% CI: 0.26-0.48
Significant
Yes
saccharomyces boulardii→nausea
nausea (RR=0.50, 95% CI: 0.37-0.68)
Finding
No significant difference
Magnitude
RR=0.50, 95% CI: 0.37-0.68
Significant
Yes
saccharomyces boulardii→taste disorders
However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.
Finding
No significant difference
Significant
No
saccharomyces boulardii→vomiting
However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.
Finding
No significant difference
Significant
No