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Vol. 63, No. 1, 2001
Issue release date: 2001
Digestion 2001;63:1–7

Effect of Lactobacillus GG Supplementation on Antibiotic-Associated Gastrointestinal Side Effects during Helicobacter pylori Eradication Therapy: A Pilot Study

Armuzzi A. · Cremonini F. · Ojetti V. · Bartolozzi F. · Canducci F. · Candelli M. · Santarelli L. · Cammarota G. · De Lorenzo A. · Pola P. · Gasbarrini G. · Gasbarrini A.
Departments of aInternal Medicine, bHygiene and cMedical Pathology, Catholic University, Rome, and Department of dHuman Nutrition, Tor Vergata University, Rome, Italy

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Background: One-week triple therapy is currently regarded as the reference of anti-Helicobacter pylori treatment. However, antibiotic-associated gastrointestinal side effects are among the major pitfalls of such regimens. Probiotic supplementation may be regarded as a therapeutic tool to prevent or reduce these troublesome drug-related manifestations. Aim: To determine whether the addition of the probiotic Lactobacillus GG to an anti-H. pylori standard triple therapy could help to prevent or minimize the occurrence of gastrointestinal side effects. Methods: One hundred and twenty healthy asymptomatic subjects screened positive for H. pylori infection and deciding to receive eradication therapy were randomized either to 1-week pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), tinidazole (500 mg b.i.d.) or to the same regimen supplemented with Lactobacillus GG for 14 days. Patients filled in validated questionnaires during follow-up to determine the type and severity of side effects and to judge overall tolerability. Results: Bloating, diarrhea and taste disturbances were the most frequent side effects during the eradication week and were significantly reduced in the Lactobacillus GG-supplemented group (RR = 0.4, CI 0.2–0.8; RR = 0.3, CI 0.1–0.8; RR = 0.3, CI 0.1–0.7, respectively). The same pattern was observed throughout the follow-up period. Overall assessment of treatment tolerability showed a significant trend in favor of the Lactobacillus GG-supplemented group (p = 0.03). Conclusions:Lactobacillus GG supplementation beneficially affects H. pylori therapy-related side effects and overall treatment tolerance.

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  1. The European Helicobacter pylori Study Group: Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. Gut 1997;41:8–13.
  2. Harris A: Current regimens for treatment of Helicobacter pylori infection. Br Med Bull 1998;54:195–205.
  3. Penston JG, McColl KEL: Eradication of Helicobacter pylori: An objective assessment of current therapies. Br J Clin Pharmacol 1997;43:223–243.
  4. Gasbarrini A, Ojetti V, Armuzzi A, Branca G, Canducci F, Sanz Torre E, Candelli M, Pastorelli A, Anti M, Fedeli G, Fadda G, Pola P, Gasbarrini G: Efficacy of a multistep strategy for Helicobacter pylori eradication. Aliment Pharmacol Ther 2000;14:79–83.
  5. Cammarota G, Cannizzaro O, Ojetti V, Cianci R, Pastorelli A, Armuzzi A, Gentiloni N, Gasbarrini A, Pirozzi G, Gasbarrini G: Five-day regimens containing ranitidine bismuth citrate plus high-dose clarithromycin and either amoxicillin or tinidazole for Helicobacter pylori infection. Aliment Pharmacol Ther 2000;14:73–77.

    External Resources

  6. Deltenre M, Ntounda R, Jonas C, De Koster E: Eradication of Helicobacter pylori: Why does it fail? Ital J Gastroenterol Hepatol 1998;30(suppl 3):S326–S328.
  7. de Boer WA, Tytgat GNJ: The best therapy for Helicobacter pylori infection: Should efficacy or side-effect profile determine our choice? Scand J Gastroenterol 1995;30:401–407.
  8. Marteau P, Rambaud JC: Potential of using lactic acid bacteria for therapy and immunomodulation in man. FEMS Microbiol Rev 1993;12:207–220.
  9. Nord CE, Heimdal A, Kager L: Antimicrobial induced alterations of the human oropharyngeal and intestinal microflora. Scand J Infect Dis 1986;49:64–72.
  10. Adamsson I, Nord CE, Lundquist P, Sjostedt S, Edlund C: Comparative effects of omeprazole, amoxycillin, plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients. J Antimicrob Chemother 1999;44:629–640.

    External Resources

  11. Lewis SJ, Freedman AR: The use of biotherapeutic agents in the prevention and treatment of gastrointestinal disease. Aliment Pharmacol Ther 1998;12:807–822.
  12. Saxelin M: Lactobacillus GG – A human probiotic strain with thorough clinical documentation. Food Rev Int 1997;13:293–313.
  13. Gasbarrini G, Gasbarrini A, Anti M, Armuzzi A, Franceschi F, Lippi ME, Candelli M, Paolucci M, Cicconi V, Cammarota G, Pretolani S, Stroffolini T: The CUE (Catholic University Epidemiological) study: Prevalence of H. pylori infection in a population working at a university hospital. Gut 1998;43(suppl 2):A43.
  14. de Boer WA, Thys JC, Borody TJ, Graham DY, O’Morain CO, Tytgat GNJ: Proposal for use of a strandard side effect scoring system in studies exploring Helicobacter pylori treatment regimens. Eur J Gastroenterol Hepatol 1996;8:641–643.
  15. Peura D: Helicobacter pylori: Rational management options. Am J Med 1998;105:424–430.
  16. Fuller R: Probiotics in human medicine. Ann Med 1990;22:37–41.
  17. Isolauri E, Kaila M, Mikkanen H, Ling WH, Salminen S: Oral bacteriotherapy for viral gastroenteritis. Dig Dis Sci 1994;12:2595–2600.
  18. Hilton E, Kolakowski P, Singer C, Smith M: Efficacy of Lactobacillus GG as a diarrheal preventive in travelers. J Trav Med 1997;4:41–43.

    External Resources

  19. Biller JA, Katz AJ, Flores AF, Buie TM, Gorbach SL: Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. J Pediatr Gastroenterol Nutr 1995;21:224–226.
  20. Siitonen S, Vapaatalo H, Salminen S, Gordin A, Saxelin M, Wikberg R, Kirkkola AL: Effect of Lactobacillus GG yoghurt in prevention of antibiotic associated diarrhoea. Ann Med 1990;22:57–59.
  21. Arvola T, Laiho K, Torkkeli S, Mykkanen H, Salminen S, Maunula L, Isolauri E: Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: A randomized study. Pediatrics 1999;104:64.
  22. Vandehoof JA, Whitney DB, Antonson DL, Hanner TL, Lupo JV, Young RJ: Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr 1999;135:564–568.
  23. Charteris WP, Kelly PM, Morelli L, Collins JK: Antibiotic susceptibility of potentially probiotic Lactobacillus species. J Food Prot 1998;61:1636–1643.
  24. Goldin BR, Gorbach SL, Saxelin M, Barakat S, Gualtieri L, Salminen S: Survival of Lactobacillus species (strain GG) in human gastrointestinal tract. Dig Dis Sci 1992;37:121–128.
  25. de Boer WA, Driessen WMM, Jansz AR, Tytgat GNJ: Effect of acid suppression on efficacy of treatment for Helicobacter pylori infection. Lancet 1995;345:817–820.

    External Resources

  26. Borody TJ, Andrews P, Fracchia G, Brandl S, Shortis NP, Bae H: Omeprazole enhances efficacy of triple therapy in eradicating Helicobacter pylori. Gut 1995;37:477–481.

    External Resources

  27. Thys JC, van Zwet AA, Oey HB: Efficacy and side effects of a triple drug regimen for the eradication of Helicobacter pylori. Scand J Gastroenterol 1993;28:934–938.
  28. Tomomasa T, Kuroume T, Arai H, Wakasashi K, Itoh Z: Erythromycin induces migrating motor complexes in human gastrointestinal tract. Dig Dis Sci 1986;31:157–161.

    External Resources

  29. Bortolotti M, Brunelli F, Sarti P, Mari C, Miglioli M: Effects of oral clarithromycin and amoxicillin on interdigestive gastrointestinal motility of patients with functional dyspepsia and Helicobacter pylori gastritis. Aliment Pharmacol Ther 1998;12:1021–1025.

    External Resources

  30. de Boer WA, Driessen WMM, Potters HVPJ, Tytgat GNG: Randomized study comparing one with two weeks of quadruple therapy for eradicating Helicobacter pylori. Am J Gastroenterol 1994;89:1993–1997.

    External Resources

  31. Michetti P, Dorta G, Wiesel PH, Brassart D, Verdu E, Herranz M, Felley C, Porta N, Rouvet M, Blum AL, Corthesy-Theulaz I: Effect of whey-based culture supernatant of Lactobacillus acidophilus (johnsonii) La1 on Helicobacter pylori infection in humans. Digestion 1999;60:203–209.

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