Probiotics in helicobacter pylori infection

The combination of a proton pump inhibitor and two antibiotics (amoxicillin plus clarithromycin or metronidazole) has been the recommended first-line therapy since the first guidelines for Helicobacter pylori (H. pylori) infection in children. In recent years, the success of eradication therapies has declined, in part due to the development of H. pylori resistant strains. Alternative anti-H. pylori treatments are currently becoming more popular than the traditional eradication methods. In vitro-studies demonstrated an inhibitory activity of probiotics on H. pylori growth and this effect is extremely strain specific. Different biologic effects have been described for probiotics, including the synthesis of antimicrobial substances as lactic acid, hydrogen peroxide and bacteriocins, the competitive interaction with pathogens for microbial adhesions sites and finally the modulation of the immune response of the host. Available data in children indicate that probiotics seem to be efficacious for the prevention of antibiotic associated side-effects, and might be of help for the prevention of H. pylori complications by decreasing H. pylori density and gastritis, and for the prevention of H. pylori colonization or re-infection by inhibiting adhesion to gastric epithelial cells. Components that may be used either as a monotherapy or, in combination with antibiotics, resulting in a more effective anti-H. pylori therapy have been investigated in depth by several researchers. Nevertheless, many questions remain unanswered. In thischapter we discuss the actual knowledge about the effects of the addition of probiotics to H. pylori eradication therapy.