DC Deza et al. AJG 2025. 120:p 2644-2659. Probiotics Prescribed With Helicobacter pylori Eradication Therapy in Europe: Usage Pattern, Effectiveness, and Safety. Results From the European Registry on Helicobacter pylori Management (Hp-EuReg) Thanks to Ben Gold for this reference.

Methods: Prospective European registry with 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. The analysis of the effectiveness of probiotics was restricted to those receiving first-line therapy.

Key findings:

• Overall, the eradication rate was 90.6% with probiotics and 86.1% without probiotics.
• With quadruple therapy, the eradication rate was 93.1% with probiotics and 89.3% without probiotics

Discussion Points:

• “The prevalence of H pylori infection remains close to 45% in the European population”
• The population receiving probiotics may have been expected to have a higher risk of eradication failure (eg. antibiotic resistance and more prior treatments) and/or higher expectations of adverse effects
• This was NOT a randomized study which limits a more definitive conclusion on the effectiveness of adding a probiotic

My take: In highly-motivated families, probiotics may be worthwhile as part of an H pylori eradication regimen. This could, of course, necessitate changes in nomenclature. Would quadruple therapy with probiotics be called 5-drug (quintuple) treatment?

Related blog posts:

H pylori:

• 5 Rights and H pylori Treatment and H Pylori Study Methods
• Dr. Benjamin Gold: 2024 Pediatric H pylori Guidelines (Part One)
• Dr. Benjamin Gold: 2024 Pediatric H pylori Guidelines (Part 2)
• Give the Right Dose (for H pylori) -It Works Better!
• Next-Generation Treatment for H Pylori

Probiotics:

• End of the Line for Probiotics for Preterm Infants
• “Efficacy” of Probiotics in Irritable Bowel Syndrome
• Cochrane Review: Probiotics NOT Proven Effective for Acute Gastroenteritis
• AGA Practice Guidelines: Probiotics NOT Helpful for Most GI Conditions
• Probiotics for Colic -Another Negative Study