saccharomyces boulardii and Increased Helicobacter pylori Eradication Rate

Research synthesisHigh evidenceSmall effect4 studies · 3 beneficial · 1 neutral · 0 harmful

The evidence from 4 studies (3 beneficial, 1 neutral) indicates that adjunctive Saccharomyces boulardii supplementation yields a small increase in Helicobacter pylori eradication rates compared to standard therapy alone. The most supportive data come from a large meta-analysis of 11 RCTs (n=2,295), which found a 12% relative improvement (RR=1.12; 95% CI: 1.06-1.18). Doses and treatment duration varied, with the median study duration being approximately 27 days. The evidence is strongest for concurrent use with bismuth quadruple or triple therapy.

Studied populations: Adults with H. pylori infection, including those with non-ulcer dyspepsia.

Caveats: Available evidence is overwhelmingly positive — clinical literature in this area is subject to publication bias (null-result studies are less likely to be published or indexed). The effect size is consistently small (approximately 9-12% relative improvement), and one well-conducted RCT found no significant benefit when S. boulardii was added to a vonoprazan-amoxicillin dual regimen, suggesting the benefit may depend on the background therapy used.

Generated Jun 9, 2026

Doses used in studies

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

Time to effect

Median: 3.9 weeks · IQR 2.6 weeks–5.1 weeks · Range 10 days–6.3 weeks — Reported in 2 of 4 studies

Safety in these studies

abdominal distentionIncreased riskRR = 0.39, 95% CI: 0.26-0.59
abdominal distention (RR = 0.39, 95% CI: 0.26-0.59)
from: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicoba
constipationIncreased riskRR = 0.32, 95% CI: 0.18-0.55
constipation (RR = 0.32, 95% CI: 0.18-0.55)
from: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicoba
diarrheaIncreased riskRR = 0.28, 95% CI: 0.22-0.36
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)
from: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicoba
nauseaIncreased riskRR = 0.59, 95% CI: 0.36-0.97
nausea (RR = 0.59, 95% CI: 0.36-0.97)
from: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicoba
rashIncreased riskRR = 0.49, 95% CI: 0.28-0.86
rash (RR = 0.49, 95% CI: 0.28-0.86)
from: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicoba
Overall tolerabilityNo significant differenceThe H. pylori eradication rates of VAS and ECAB groups by intention-to-treat analysis were 87.3% and 88.9% (P = 1.000) and by per-protocol analysis were 87.3% and 91.8% (P = 0.560), respectively. The ECAB group had a significantly higher incidence of adverse events than the VAS group.
The ECAB group had a significantly higher incidence of adverse events than the VAS group.
from: Effectiveness and safety of vonoprazan and amoxicillin dual regimen with Saccharomyces bou
Overall tolerabilityReported
The VAS group had a significantly lower incidence of adverse events than the ECAB group.
from: Effectiveness and safety of vonoprazan and amoxicillin dual regimen with Saccharomyces bou
Overall tolerabilityReported
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).
from: Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicoba
Overall tolerabilityReported
this approach demonstrated advantages in alleviating symptoms, exhibited favorable tolerance, and maintained a high level of clinical safety.
from: Saccharomyces boulardii combined with triple therapy alter the microbiota in the eradicati
adverse reactionsReported
Microbial composition, eradication rates, symptom alleviation, and adverse reactions were monitored on the 14th and 44th days post-treatment.
from: Saccharomyces boulardii combined with triple therapy alter the microbiota in the eradicati
diarrhoeaReportedRR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03
pronounced reductions in diarrhoea (n = 2,091; RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03)
from: Efficacy and Safety of Saccharomyces Boulardii with Standard Quadruple Therapy for Eradica
gastrointestinal side effectsReported
the combination of Saccharomyces boulardii powder with triple therapy displayed notable efficacy and smaller gastrointestinal side effects in eradicating initial H. pylori infections among non-ulcer dyspepsia patients.
from: Saccharomyces boulardii combined with triple therapy alter the microbiota in the eradicati
rashReportedRR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01
and rash occurrence (n = 1,271; RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01)
from: Efficacy and Safety of Saccharomyces Boulardii with Standard Quadruple Therapy for Eradica
treatment-related adverse eventsReportedRR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002
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)
from: Efficacy and Safety of Saccharomyces Boulardii with Standard Quadruple Therapy for Eradica

4 of 4 papersPopulation:

Efficacy and Safety of Saccharomyces Boulardii with Standard Quadruple Therapy for Eradication of Helicobacter Pylori in Adults: Meta-Analysis.
- 2025-11-01
- Meta-Analysis · n = 295
- Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 35(11)
- - Fengzhen Ma
  - Heyin Huang
  - Kanglin Tian
  - Wei Wang
- PubMed: 41247686
- DOI: 10.29271/jcpsp.2025.11.1440
1 Insight on
- Increased Helicobacter pylori Eradication Rate
- High evidence
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
Significant
Yes
Saccharomyces boulardii combined with triple therapy alter the microbiota in the eradication of Helicobacter pylori infection.
- 2024-06-07
- RCT · n = 144
- Scientific reports 14(1)
- - Yan Zhang
  - Bingyun Lu
  - Yu Dong
  - Yifeng Zhang
  - Qianming Du
  - Ye Chen
  - Zhenyu Zhang
- PubMed: 38849408
- DOI: 10.1038/s41598-024-63894-z
2 Insights on
- Increased Helicobacter pylori Eradication Rate
- High evidence
- Large Human Trial
- Rigorous Journal
- Clinical
According to PP analysis showed the eradication rates for the SRAC group was 75%, BRAC was 93.18% and RAC was 65.2%. Group BRAC exhibited a marginally higher eradication rate compared to other groups.
Effect
Beneficial
Effect size
Moderate
Significant
Yes
Effectiveness and safety of vonoprazan and amoxicillin dual regimen with Saccharomyces boulardii supplements on eradication of Helicobacter pylori.
- 2024-11-26
- RCT · n = 126
- BMC gastroenterology 24(1)
- - Jing Yu
  - Chen Cui
  - Kai Ma
  - Peng Yang
  - Yizhou Jiang
  - Xiaoyong Wang
- PubMed: 39592940
- DOI: 10.1186/s12876-024-03524-0
1 Insight on
- Increased Helicobacter pylori Eradication Rate
- High evidence
- Large Human Trial
- Clinical
The H. pylori eradication rates of VAS and ECAB groups by intention-to-treat analysis were 87.3% and 88.9% (P = 1.000) and by per-protocol analysis were 87.3% and 91.8% (P = 0.560), respectively.
Effect
Neutral
Effect size
Small
Significant
No
Dose
250 mg twice/day for 10 days
Effect of Saccharomyces boulardii supplementation to bismuth quadruple therapy on Helicobacter pylori eradication.
- 2025-04-18
- Meta-Analysis
- 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
7 Insights on
- Increased Helicobacter pylori Eradication Rate
- High evidence
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
Significant
Yes
Dose
500 mg/day or 1000 mg/day

saccharomyces boulardii and Increased Helicobacter pylori Eradication Rate

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

Saccharomyces boulardii combined with triple therapy alter the microbiota in the eradication of Helicobacter pylori infection.

Effectiveness and safety of vonoprazan and amoxicillin dual regimen with Saccharomyces boulardii supplements on eradication of Helicobacter pylori.

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