Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis

Helicobacter. 2019 Oct;24(5):e12651. doi: 10.1111/hel.12651. Epub 2019 Aug 14.


Background and aims: Whether Saccharomyces boulardii (S boulardii) as an adjuvant therapy are beneficial to H pylori eradication remains controversial. The aim of the study was to update and determine the effects of S boulardii as an adjuvant therapy on H pylori eradication rates and adverse effects.

Methods: We searched PubMed, Embase, CENTRAL, and Web of Science to collect all randomized controlled trials assessing the effects of S boulardii as an adjuvant therapy for H pylori eradication from inception to February 2019. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis was performed to control the risk of type I and type II errors.

Results: Eighteen trials with 3592 patients were eligible for meta-analysis. Compared with standard eradication regimen, the S boulardii supplementation could significantly improve eradication rates [risk ratio (RR) = 1.09, 95% confidence interval (CI):1.05-1.13; moderate quality evidence] and reduce the incidence of total side effects (RR = 0.47, 95%CI:0.36-0.61; low quality evidence), as well as some gastrointestinal adverse effects, especially diarrhea (RR = 0.33, 95%CI:0.23-0.47; low quality evidence) and constipation (RR = 0.37, 95%CI:0.23-0.57; moderate quality evidence). In addition, the need for discontinuation rate in S boulardii supplementation group was significantly lower than in the control group (RR = 0.33, 95%CI:0.16-0.69, P = .003; moderate quality evidence). The TSA results for overall eradication rates and total side effects indicated that the effects were conclusive.

Conclusions: Our meta-analysis shows that S boulardii supplementation on standard eradication therapy significantly increased H pylori eradication rates and reduced the incidence of total side effects and some gastrointestinal adverse effects during eradication therapy.

Keywords: Helicobacter pylori; Saccharomyces boulardii; meta-analysis; trial sequential analysis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Drug Therapy, Combination / methods
  • Female
  • Helicobacter Infections / therapy*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Probiotics / administration & dosage*
  • Proton Pump Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Saccharomyces boulardii / growth & development*
  • Treatment Outcome
  • Young Adult


  • Anti-Bacterial Agents
  • Proton Pump Inhibitors