Probiotic supplementation in the treatment of Helicobacter pilory infection in Italy: data from Italian registry on H. pylori treatment

Background and aim: Probiotic supplementation appears to have a beneficial effect in reducing gastrointestinal adverse events caused by Helicobacter (H.) pylori eradication therapies. The aim of this study was to investigate the use of probiotic supplementation in the treatment of H. pylori infection in clinical practice in Italy. Material and methods:The “Italian Registry on H. pylori treatment” is an online database prospectively registering adult patients prescribed with a treatment for H. pylori infection by gastroenterologists in Italy. Data were collected from 18 centers from June 2017 to October 2018 using the web application REDCap (Research Electronic Data Capture). Results:A total of 1069 patients [679 (63.8%) females, mean age (SD): 54.0 years (15.3)] were assessed. Of these, 1009 patients received one treatment, 58 two treatments and 2 three treatments for H. pylori eradication, with a total of 1131 treatment regimens. Concomitant probiotic supplementation was prescribed with 52.3% (592/1131) of antimicrobial regimens. Probiotics were prescribed in 95% (37/39) of cases treated with rifabutin-containing triple therapy, 89.2% (331/371) with sequential therapy, 58% (29/50) with concomitant therapy, 44% (37/84) with levofloxacin-containing triple therapy, 32.1% (115/358) with the new formulation of bismuth quadruple therapy (Pylera ® ), 18.7% (41/219) with clarithromycin-containing triple therapy and 20% (2/10) with other regimens. The most frequently prescribed probiotic was a combination of Lactobacillus rhamnosus and Bifidobacterium breve (Prolactis ® , OMEGA Pharma) (66%, 391/592), followed by Lactobacillus casei DG (Enterolactis Plus ® , Sofar, Italy) (12.5%, 74/592), Lactobacillus rhamnosus (Dicoflor complex ® , AG Pharma SRL) (9.6%, 57/592), Saccaromyces boulardii (Codex ® , Zambon, Italy) (7.1%, 42/592) and other probiotics (4.7%, 28/592). Conclusions: Probiotics appear to be used in about half of patients receiving antimicrobial regimens for H. pylori eradication in Italy. Probiotic supplementation is mostly prescribed with rifabutin-containing triple therapy and sequential therapy. Lactobacillus and Bifidobacterium are the most common prescribed probiotics.