The effect of synbiotics in improving Helicobacter pylori eradication: A systematic review and meta-analysis

Background: Helicobacter pylori is a common human infection, presenting in half of the world's population. The failure of the Helicobacter pylori eradication rate necessitates the assessment of new options. The aim of the present meta-analysis was therefore to assess the role of synbiotics in Helicobacter pylori eradication therapy. Methods: A comprehensive literature search was conducted using PubMed, Google Scholar, Scopus, and Web of Knowledge up to June 2018 to identify all randomized controlled trials assessing the effect of synbiotics on the treatment of Helicobacter pylori. A random-effects model was applied for pooling analysis to compensate for the heterogeneity of included studies. The Cochrane Risk of Bias Tool was applied to assess potential bias risks. Results: A total of 6 randomized controlled trials were found which assessed the effect of synbiotics on Helicobacter pylori eradication rate. The pooled effect size of the intention-to-treat showed that synbiotics can improve eradication rate (RR: 1.28; 95% CI: 1.15-1.43; I-2 = 0%). Also, common adverse events resulting from antibiotics therapy were significantly reduced by adding synbiotics to conventional antibiotics treatments (RR: 0.47; 95% CI: 0.25-0.90; I-2 = 36%). However, no difference in eradication rate was observed from per-protocol treatment between intervention and control groups (RR: 0.90; 95% CI: 0.69-1.16; I-2 = 88%). Conclusion: The present systematic review and meta-analysis suggested synbiotics might improve Helicobacter pylori eradication rates, and reduce adverse effects. However, these findings assessed a low number of studies, and further high-quality studies are needed to confirm these results.