Treating bacteria with bacteria: the role of probiotics in the eradication of Helicobacter pylori

Helicobacter pylori (H. pylori), with more than 50% global population infection, is an etiology of chronic gastritis and peptic ulcer and a risk factor for gastric malignancies. Due to the increase of H. pylori-resistant strains and treatment-related adverse effects, the success rate of eradication therapies has declined to 70%, far below the initial rate of 90%. To improve the eradication rate, researchers have started to look into alternative treatments for H. pylori, one of which is probiotics. In this article, we elaborated the mechanisms of action of probiotics against H. pylori infection into four aspects: immunomodulation, antimicrobial substances, interfering with adhesion, and mucosal barrier. Although probiotics are varied, we only conducted studies on Lactobacillus, Bifidobacterium, and yeasts such as Saccharomyces boulardii most commonly used in the therapy. The effects of Lactobacillus, Bifidobacterium, and Saccharomyces boulardiias monotherapy or adjuvant therapy combined with antibiotic-PPI for H. pylori eradication in children and adults showed diverse outcomes in eradication rate and adverse effects. Extensive studies indicated probiotics plays an important role in H. pylori infection. However, many uncertain problems still need to be considered in the clinical application of probiotics.