Effectivness of Probiotic on Treatment of Helicobacter Pylori Infection in Children

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Pediatrics, Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan. Iran

2 Resident, Department of Pediatrics, Child Health Promotion Research Center, School of Medicine And Student Research Committee , Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Helicobacter pylori (H.Pylori) is the most common chronic bacterial infection. In children it can cause malnutrition, anemia, gastrointestinal distress and failure to thrive. Unfortunately the treatment fails in 20% of patients because of low compliance, drug resistance and treatment’s side effects. Since probiotics have an anti bacterial effect, they can reduce the complications of treatment. In this study we evaluated probiotic effect in Hp. eradication in children.Methods: This study was a randomized clinical trial in which 50 children with HP infection was divided in two treatment groups. In one group 25 children were treated by triple treatment (Amoxicillin, claritromycin, omeprazol) and probiotic (Protexin). Triple treatment and placebo was done to treat other 25 children in placebo group. We checked patients before treatment, and 14 days after treatment and also 2 and 4 weeks after terminating the treatment. In each visit the signs and symptoms and drug adherence was investigated. In the last visit we did UBT. The results were analyzed by χ2 and Fisher’s exact tests.Findings: HP eradication in case group was 100% and in control group was 92% (P = 0.24). The prevalence of diarrhea, nausea, metallic taste in case group was significantly lower than control group, but the prevalence of constipation, vomiting, abdominal pain, low appetite, bloating was not different in two groups. In case AND Control groups 1.2% and 3.2% of drugs was not eaten respectively.  Conclusion: Based on our results we suggest probiotics only for reducing treatment's complications and increasing compliance in H.pylori treatment but not for eradication of infection.  

Keywords


  1. Gold BD, Colletti RB, Abbott M, Czinn SJ, Elitsur Y, Hassall E, et al. Helicobacter pylori infection in children: recommendations for diagnosis and treatment. J Pediatr Gastroenterol Nutr 2000; 31(5): 490-7.
  2. Bourke B, Ceponis P, Chiba N, Czinn S, Ferraro R, Fischbach L, et al. Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation. Can J Gastroenterol 2005; 19(7): 399-408.
  3. Crowe SE. Bacteriology and epidemiology of Helicobacter pylori infection [Online] 2011 May [cited 2011 Mar 29]; Available from URL:http://www.uptodate.com/contents/bacteriology-and-epidemiology-of-helicobacter-pylori-infection.
  4. Koletzko S, Richy F, Bontems P, Crone J, Kalach N, Monteiro ML, et al. Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe. Gut 2006; 55(12): 1711-6.
  5. Oderda G, Shcherbakov P, Bontems P, Urruzuno P, Romano C, Gottrand F, et al. Results from the pediatric European register for treatment of Helicobacter pylori (PERTH). Helicobacter 2007; 12(2): 150-6.
  6. Tong JL, Ran ZH, Shen J, Zhang CX, Xiao SD. Meta-analysis: the effect of supplementation with probiotics on eradication rates and adverse events during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther 2007; 25(2): 155-68.
  7. Sartor RB. Probiotics for Gastrointestinal Diseases. Uptodate 19.2 [Online] 2011. Available from: URL:
  8. http://www.uptodate.com/contents/probiotics-for-gastrointestinal-diseases
  9. Bhatia SJ, Kochar N, Abraham P, Nair NG, Mehta AP. Lactobacillus acidophilus inhibits growth of Campylobacter pylori in vitro. J Clin Microbiol 1989; 27(10): 2328-30.
  10. Bernet MF, Brassart D, Neeser JR, Servin AL. Lactobacillus acidophilus LA 1 binds to cultured human intestinal cell lines and inhibits cell attachment and cell invasion by enterovirulent bacteria. Gut 1994; 35(4): 483-9.
  11. Sykora J, Valeckova K, Amlerova J, Siala K, Dedek P, Watkins S, et al. Effects of a specially designed fermented milk product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori in children: a prospective randomized double-blind study. J Clin Gastroenterol 2005; 39(8): 692-8.
  12. Goldman CG, Barrado DA, Balcarce N, Rua EC, Oshiro M, Calcagno ML, et al. Effect of a probiotic food as an adjuvant to triple therapy for eradication of Helicobacter pylori infection in children. Nutrition 2006; 22(10): 984-8.
  13. Szajewska H, Albrecht P, Topczewska-Cabanek A. Randomized, double-blind, placebo-controlled trial: effect of lactobacillus GG supplementation on Helicobacter pylori eradication rates and side effects during treatment in children. J Pediatr Gastroenterol Nutr 2009; 48(4): 431-6.
  14. Thomas DW, Greer FR. Probiotics and prebiotics in pediatrics. Pediatrics 2010; 126(6): 1217-31.
  15. Ofman JJ, Etchason J, Fullerton S, Kahn KL, Soll AH. Management Strategies for Helicobacter pylori-Seropositive patients with dyspepsia: Clinical and economic consequences. Ann Intern Med 1997; 126(4): 280-91.
  16. Lionetti E, Miniello VL, Castellaneta SP, Magista AM, de Canio A, Maurogiovanni G, et al. Lactobacillus reuteri therapy to reduce side-effects during anti-Helicobacter pylori treatment in children: a randomized placebo controlled trial. Aliment Pharmacol Ther. 2006; 24(10): 1461-8.