saccharomyces boulardii and Improved H Pylori Eradication Rates

Research synthesisModerate evidenceMixed effect size8 studies · 5 beneficial · 3 neutral · 0 harmful

Across 8 studies, 5 reported beneficial effects and 3 found no significant benefit, with effect sizes ranging from small to large (mixed). Most evidence comes from meta-analyses of clinical trials in H. pylori-infected populations, including children and treatment-resistant adults, with a median treatment duration of 14 days.

Studied populations: clinical populations with Helicobacter pylori infection, including children and adults with previous treatment failure

Caveats: Three of eight studies showed no significant benefit, suggesting the effect may be modest and not universal. Many included studies are meta-analyses that may share overlapping patient data. Treatment duration was typically only 14 days; longer-term outcomes are not well studied. Dosing was inconsistently reported, so no clear dose-response relationship can be determined.

Generated Jul 10, 2026

Doses used in studies

mg/day: 500–1,000 (median 750, IQR 625–875) — 2 studies

Time to effect

Median: 2 weeks · IQR 2 weeks–2 weeks · Range 2 weeks–2 weeks — Reported in 2 of 8 studies

Safety in these studies

Overall tolerabilityNo significant difference
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)
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
abdominal distensionNo significant differenceRR=0.49, 95% CI: 0.33-0.72
abdominal distension (RR=0.49, 95% CI: 0.33-0.72)
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
abdominal gasNo significant difference
Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups.
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
abdominal painNo significant difference
However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
constipationNo significant differenceRR=0.38, 95% CI: 0.26-0.57
constipation (RR=0.38, 95% CI: 0.26-0.57)
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
diarrheaNo significant difference14.5% vs 30.6%
Nine (14.5%) patients in the treatment group and 19 (30.6%) patients in the placebo group experienced diarrhea (p < .05).
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
diarrheaNo significant differenceRR=0.36, 95% CI: 0.26-0.48
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)
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
diffuse abdominal painNo significant difference
Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups.
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
epigastric discomfortNo significant difference14.5% vs 43.5%
Epigastric discomfort was more frequent in the control group [9 (14.5%) versus 27 (43.5%), respectively (p < .01)].
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
nauseaNo significant difference
Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups.
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
nauseaNo significant differenceRR=0.50, 95% CI: 0.37-0.68
nausea (RR=0.50, 95% CI: 0.37-0.68)
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
taste disordersNo significant difference
However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
taste disturbanceNo significant difference
Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups.
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
urticariaNo significant difference
Diffuse abdominal pain, abdominal gas, taste disturbance, urticaria, nausea symptoms were similar in both groups.
from: Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylo
vomitingNo significant difference
However, it did not reduce the occurrence of abdominal pain, vomiting, or taste disorders.
from: Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication
_overall adverse reactionsReported
The overall incidence of adverse reactions and the incidence of diarrhea and nausea in the simultaneous probiotic group, and the there after probiotic group were lower than those in the quadruple group(P<0.05),and the difference was statistically significant.
from: [Influence of different timing of Saccharomyces boulardii combined with bismuth quadruple
abdominal distentionReported4.9% vs. 12.7%, RR = 0.41, 95% CI: 0.23-0.72, p = 0.002
abdominal distention (4.9% vs. 12.7%, RR = 0.41, 95% CI: 0.23-0.72, p = 0.002)
from: The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for
adverse eventsReported
The incidence of adverse events was significantly lower in the VAS group (11.6%) than it was in the VA group (32.6%; P < 0.001).
from: Vonoprazan-Amoxicillin Dual Therapy with or Without Saccharomyces boulardii Supplementatio
constipationReported2.9% vs. 8.4%, RR = 0.35, 95% CI: 0.14-0.88, p = 0.03
constipation (2.9% vs. 8.4%, RR = 0.35, 95% CI: 0.14-0.88, p = 0.03)
from: The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for
diarrheaReported7.9% vs. 25.7%, RR = 0.29, 95% CI: 0.17-0.48, p < 0.00001
diarrhea (7.9% vs. 25.7%, RR = 0.29, 95% CI: 0.17-0.48, p < 0.00001)
from: The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for
diarrheaReported
The overall incidence of adverse reactions and the incidence of diarrhea and nausea in the simultaneous probiotic group, and the there after probiotic group were lower than those in the quadruple group(P<0.05),and the difference was statistically significant.
from: [Influence of different timing of Saccharomyces boulardii combined with bismuth quadruple
nauseaReported
The overall incidence of adverse reactions and the incidence of diarrhea and nausea in the simultaneous probiotic group, and the there after probiotic group were lower than those in the quadruple group(P<0.05),and the difference was statistically significant.
from: [Influence of different timing of Saccharomyces boulardii combined with bismuth quadruple
overall adverse eventsReported22% vs. 39%, RR = 0.56, 95% CI: 0.44-0.70, p < 0.00001
The combination of S. boulardii and BQT had a significantly lower rate of overall adverse events (22% vs. 39%, RR = 0.56, 95% CI: 0.44-0.70, p < 0.00001)
from: The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for

8 of 8 papersPopulation:

The effect of Saccharomyces boulardii supplementation on Helicobacter pylori eradication in children: a systematic review and meta-analysis of Randomized controlled trials.
- 2023-12-15
- Meta-Analysis · n = 2,156
- BMC infectious diseases 23(1)
- - Lian-Hua Liu
  - Bin Han
  - Jing Tao
  - Kai Zhang
  - Xi-Ke Wang
  - Wen-Yu Wang
- PubMed: 38102568
- DOI: 10.1186/s12879-023-08896-4
10 Insights on
- Improved H Pylori Eradication Rates
- High evidence
- Clinical
S. boulardii in combination with STT was more effective than STT alone (intention-to-treat analysis : 87.7% vs. 75.9%, RR = 1.14, 95% CI: 1.10-1.19, P < 0.00001)
Effect
Beneficial
Effect size
Moderate
Significant
Yes
The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for eradicating Helicobacter pylori: a systematic review and meta-analysis of randomized controlled trials.
- 2024-04-17
- Systematic Review · n = 404
- Frontiers in medicine 11
- - Yin Chen
  - Tao Teng
  - Yu Su
  - Wen-Zhong Chen
- PubMed: 38695028
- DOI: 10.3389/fmed.2024.1344702
4 Insights on
- Improved H Pylori Eradication Rates
- High evidence
- Clinical
The results of the intention-to-treat analysis showed that the combination of S. boulardii with BQT had a higher eradication rate than BQT alone (87.0% versus 83.3%), with a pooled RR of 1.05 (95% CI: 1.00-1.10, p = 0.03). In the per-protocol analysis, however, there was no statistical significance between the two groups in the eradication rate (93.7% versus 91.0%, RR = 1.03, 95% CI: 1.00-1.06, p = 0.07).
Effect
Neutral
Effect size
Small
Significant
No
Dose
not stated
[Influence of different timing of Saccharomyces boulardii combined with bismuth quadruple therapy for Helicobacter pylori eradication].
- 2019-06-01
- RCT · n = 300
- Zhonghua yi xue za zhi 99(22)
- - C X He
  - F T Kong
  - F Liang
  - K X Wang
  - H Li
  - Y L Liu
  - W Zhao
  - P P Zhou
  - F L Kong
- PubMed: 31216821
- DOI: 10.3760/cma.j.issn.0376-2491.2019.22.010
1 Insight on
- Improved H Pylori Eradication Rates
- High evidence
- Large Human Trial
- Clinical
The eradication rates of H. pylori were 89.0%, 90.4% and 91.3% in the quadruple therapy group, the simultaneous probiotic group and the there after probiotic group according to Per-protocol (PP) analysis, respectively, with no statistical difference (P=0.870). According to intention-to-treat (ITT) analysis, 81.0%, 85.0% and 84.0%, respectively, the difference was not statistically significant (P=0.732).
Effect
Neutral
Effect size
Small
Significant
No
Dose
500 mg bid
Vonoprazan-Amoxicillin Dual Therapy with or Without Saccharomyces boulardii Supplementation as a Rescue Regimen for Helicobacter pylori Infection.
- 2026-04-07
- Clinical Trial · n = 190
- Infection and drug resistance 19
- - Ding-Ni Qu
  - Ze-Xuan Ji
  - Jun-Qi Zhang
  - Xiao-Yong Wang
- PubMed: 41971394
- DOI: 10.2147/idr.s594118
2 Insights on
- Improved H Pylori Eradication Rates
- High evidence
- Clinical
Based on intention-to-treat analysis, H. pylori eradication rates were 80.0% in the VA group and 92.6% in the VAS group (P = 0.011), and per-protocol analysis yielded eradication rates of 85.4% and 94.6%, respectively (P = 0.037).
Effect
Beneficial
Effect size
Large
Significant
Yes
Dose
250 mg twice daily
The impact of probiotics on Helicobacter pylori eradication with bismuth quadruple therapy: A systematic review and meta-analysis.
- 2025-12
- Meta-Analysis
- International journal of antimicrobial agents 66(6)
- - Yu-Hao Liu
  - Ju Zhang
  - Deng-Hua Li
  - Yan-Peng Zhang
  - Jie Li
  - Qi-Qi Guo
  - Xiao-Jing Zhu
  - Yong-Quan Shi
- PubMed: 40865583
- DOI: 10.1016/j.ijantimicag.2025.107600
1 Insight on
- Improved H Pylori Eradication Rates
- High evidence
- Clinical
Subgroup analyses demonstrated that both Saccharomyces boulardii (OR = 1.62; P < 0.05) ... significantly enhanced eradication rates.
Effect
Beneficial
Effect size
Moderate
Significant
Yes
Efficacy and safety of Saccharomyces boulardii as an adjuvant therapy for the eradication of Helicobacter pylori: a meta-analysis.
- 2025-02-12
- Meta-Analysis
- Frontiers in cellular and infection microbiology 15
- - Manning Li
  - Ying Xie
- PubMed: 40012609
- DOI: 10.3389/fcimb.2025.1441185
9 Insights on
- Improved H Pylori Eradication Rates
- High evidence
- Clinical
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
Significant
Yes
Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis with trial sequential analysis
- 2019-08-14
- Meta-Analysis
- Helicobacter 24(5)
- - Ben‐Gang Zhou
  - Lingxiao Chen
  - Bohua Li
  - Lin-Yan Wan
  - Yao-Wei Ai
- PubMed: 31414551
- DOI: 10.1111/hel.12651
7 Insights on
- Improved H Pylori Eradication Rates
- High evidence
the S boulardii supplementation could significantly improve eradication rates [risk ratio (RR) = 1.09, 95% confidence interval (CI):1.05-1.13; moderate quality evidence]
Effect
Beneficial
Effect size
Small
Significant
Yes
Efficacy and Safety of Saccharomyces boulardii in the 14‐day Triple Anti‐Helicobacter pylori Therapy: A Prospective Randomized Placebo‐Controlled Double‐Blind Study
- 2007-07-30
- RCT
- Helicobacter 12(4)
- - M. Cindoruk
  - Gulbanu Erkan
  - T. Karakan
  - A. Dursun
  - S. Unal
- PubMed: 17669103
- DOI: 10.1111/j.1523-5378.2007.00516.x
6 Insights on
- Improved H Pylori Eradication Rates
- High evidence
- Highly Cited
H. pylori eradication rate, although higher in the treatment group, was statistically similar in treatment and control groups: 71% (44/62) versus 59.7% (37/62), respectively (p > .05).
Effect
Neutral
Effect size
Small
Significant
No
Dose
Not stated in abstract