Probiotics Prescribed With Helicobacter pylori Eradication Therapy in Europe: Usage Pattern, Effectiveness, and Safety. Results From the European Registry on Helicobacter pylori Management (Hp-EuReg)

December 11, 2025

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Publicated to: American Journal Of Gastroenterology. 120 (11): 2644-2659 - 2025-11-01 120(11), DOI: 10.14309/ajg.0000000000003351

Authors: Deza, DC; Alcedo, J; Lafuente, M; Lopez, FJ; Perez-Aisa, A; Pavoni, M; Tepes, B; Jonaitis, L; Castro-Fernandez, M; Pabon-Carrasco, M; Keco-Huerga, A; Voynovan, I; Bujanda, L; Lucendo, AJ; Jurecic, NB; Denkovski, M; Vologzanina, L; Rodrigo, L; Martínez-Domínguez, SJ; Fadieienko, G; Huguet, JM; Abdulkhakov, R; Abdulkhakov, SR; Alcaide, N; Velayos, B; Hernández, L; Bordin, DS; Gasbarrini, A; Kupcinskas, J; Babayeva, G; Gridnyev, O; Leja, M; Rokkas, T; Marcos-Pinto, R; Lerang, F; Boltin, D; Mestrovic, A; Smith, SM; Venerito, M; Boyanova, L; Milivojevic, V; Doulberis, M; Kunovsky, L; Parra, P; Cano-Català, A; Moreira, L; Nyssen, OP; Megraud, F; Morain, CO; Gisbert, JP

Affiliations

Agencia Sanitaria Costa Sol, Digest Unit, Marbella, Spain - Author

Althaia Xarxa Assistencial Univ Manresa FP, Gastrointestinal Oncol Endoscopy & Surg GOES Res G, Manresa, Spain - Author

AS Loginov Moscow Clin Sci Ctr, Dept Gastroenterol, Moscow, Russia - Author

AS Loginov Moscow Clin Sci Ctr, Dept Pancreat Biliary & Upper Digest Tract Disorde, Moscow, Russia - Author

Azerbaijan State Adv Training Inst Doctors A Aliye, Dept Internal Med & Gastroenterol, Baku, Azerbaijan - Author

Biodonostia Hlth Res Inst, Dept Gastroenterol, San Sebastian, Spain - Author

CIBEREHD, Zaragoza, Spain - Author

Clin Ctr Serbia, Clin Gastroenterol & Hepatol, Belgrade, Serbia - Author

Ctr Hosp Porto, Gastroenterol Dept, Porto, Portugal - Author

Ctr Invest Biomed Red Enfermedades Hepat & Digest, CIBERehd, Madrid, Spain - Author

Ctr Invest Red Enfermedades Hepat & Digest CIBEReh, CIBERehd, Madrid, Spain - Author

Ctr Res Hlth Technol & Informat Syst CINTESIS, Porto, Portugal - Author

DC Rogaska, Dept Gastroenterol, Slatina, Slovenia - Author

Digest Dis Ctr, Dept Gastroenterol, Riga, Latvia - Author

Fdn Policlin Univ Agostino Gemelli IRCCS, Med Interna & Gastroenterol, Rome, Italy - Author

Gastroctr, Perm, Russia - Author

Henry Dunant Hosp, Gastroenterol Clin, Athens, Greece - Author

Hosp Clin Univ Lozano Blesa, Serv Aparato Digest, Zaragoza, Spain - Author

Hosp Clin Valladolid, Dept Gastroenterol, Valladolid, Spain - Author

Hosp Gen Tomelloso, Dept Gastroenterol, Tomelloso, Spain - Author

Hosp Gen Univ Valencia, Dept Gastroenterol, Valencia, Spain - Author

Hosp Santos Reyes, Gastroenterol Unit, Aranda De Duero, Spain - Author

Hosp Univ Miguel Servet, Dept Gastroenterol, Zaragoza, Spain - Author

Hosp Univ Valme, Dept Gastroenterol, Seville, Spain - Author

Inst Invest Sanitaria Aragon IIS Aragon, Zaragoza, Spain - Author

Inst Invest Sanitaria Princesa, Gastroenterol, Madrid, Spain - Author

Inst Recerca I Innovacio Ciencies Vida I Salut Cat, Vic, Spain - Author

Interni Oddelek, Diagnost Ctr, Dept Gastroenterol, Bled, Slovenia - Author

Kantonsspital Aarau, Gastroenterol Dept, Aarau, Switzerland - Author

Kazan State Med Univ, Dept Hosp Med, Kazan, Russia - Author

Lithuanian Univ Hlth Sci, Res & Dept Gastroenterol, Kaunas, Lithuania - Author

Masaryk Mem Canc Inst, Dept Gastroenterol & Digest Endoscopy, Brno, Czech Republic - Author

Masaryk Univ, Univ Hosp Brno, Fac Med, Dept Surg, Brno, Czech Republic - Author

Med Univ Sofia, Dept Med Microbiol, Sofia, Bulgaria - Author

NAMS Ukraine, Govt Inst L T Malaya Therapy Natl Inst, Div Study Digest Dis & Its Comorbid Noncommunicabl, Kharkiv, Ukraine - Author

Ostfold Hosp Trust, Dept Gastroenterol, Gralum, Norway - Author

Palacky Univ Olomouc, Univ Hosp Olomouc, Fac Med & Dent, Dept Internal Med Gastroenterol & Geriatr 2, Olomouc, Czech Republic - Author

Rabin Med Ctr, Div Gastroenterol, Tel Aviv, Israel - Author

Redes Invest Cooperat Orientada Resultados Salud R, Marbella, Spain - Author

Russian Univ Med, Dept Propaedeut Internal Dis & Gastroenterol, Moscow, Russia - Author

St Orsola Malpighi Univ Hosp, Dept Med & Surg Sci, Bologna, Italy - Author

Tel Aviv Univ, Tel Aviv, Israel - Author

Trinity Coll Dublin, Fac Hlth Sci, Sch Med, Dublin, Ireland - Author

Tver State Med Univ, Dept Outpatient Therapy & Family Med, Tver, Russia - Author

Univ Autonoma Madrid UAM, Hosp Univ La Princesa, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Serv Aparato Digest, Madrid, Spain - Author

Univ Barcelona, Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain - Author

Univ Belgrade, Fac Med, Belgrade, Serbia - Author

Univ Bordeaux, INSERM, U1312, BRIC, Bordeaux, France - Author

Univ Hosp Magdeburg, Dept Gastroenterol Hepatol & Infect Dis, Magdeburg, Germany - Author

Univ Hosp Split, Dept Gastroenterol, Split, Croatia - Author

Univ Latvia, Inst Clin & Prevent Med, Riga, Latvia - Author

Univ Oviedo, Gastroenterol, Oviedo, Spain - Author

Univ Pais Vasco UPV EHU, Dept Med, San Sebastian, Spain - Author

Univ Porto, Inst Ciencias Biomed Abel Salazar, Porto, Portugal - Author

Univ Zaragoza, Fac Sci, Dept Stat Methods, Zaragoza, Spain - Author

Univ Zaragoza, Inst Biocomputac & Fis Sistemas Complejos BIFI, Zaragoza, Spain - Author

Abstract

INTRODUCTION:To evaluate the prescription patterns, effectiveness, and safety of adding probiotics to Helicobacter pylori eradication therapy, in Europe.METHODS:International, prospective, noninterventional registry of the clinical practice of the European gastroenterologists. Data were collected and quality reviewed until March 2021 at AEG-REDCap. The effectiveness was evaluated by modified intention-to-treat analysis, differentiating by geographic areas. Adverse events (AEs) were categorized as mild, moderate, and severe.RESULTS:Overall, 36,699 treatments were recorded, where 8,233 (22%) were prescribed with probiotics. Probiotics use was associated with higher effectiveness in the overall analysis (odds ratio [OR] 1.631, 95% confidence interval [CI] 1.456-1.828), as well as in triple (OR 1.702, 95% CI 1.403-2.065), quadruple (OR 1.383, 95% CI 0.996-1.920), bismuth quadruple (OR 1.248, 95% CI 1.003-1.554), and sequential therapies (OR 3.690, 95% CI 2.686-5.069). Lactobacillus genus was associated with a higher therapy effectiveness in Eastern Europe when triple (OR 2.625, 95% CI 1.911-3.606) and bismuth quadruple (OR 1.587, 95% CI 1.117-2.254) first-line therapies were prescribed. In Central Europe, the use of probiotics was associated with a decrease in both the overall incidence of AEs (OR 0.656, 95% CI 0.516-0.888) and severe AEs (OR 0.312, 95% CI 0.217-0.449). Bifidobacterium genus was associated with lower overall (OR 0.725, 95% CI 0.592-0.888) and severe (OR 0.254, 95% CI 0.185-0.347) AEs, and Saccharomyces was associated with reduced overall (OR 0.54, 95% CI 0.32-0.91) and severe (OR 0.257, 95% CI 0.123-0.536) AEs under quadruple-bismuth regimen.DISCUSSION:In Europe, the use of probiotics was associated with higher effectiveness and safety of H. pylori eradication therapy. Lactobacillus improved treatment effectiveness, whereas Bifidobacterium and Saccharomyces were associated with a better safety profile.

Keywords

<italic>bifidobacterium</italic><italic>helicobacter pylori</italic><italic>lactobacillus</italic><italic>saccharomyces</italic>EffectivenessEradication therapyGood health and well-beingProbioticsSafety

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal American Journal Of Gastroenterology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 14/147, thus managing to position itself as a Q1 (Primer Cuartil), in the category Gastroenterology & Hepatology. Notably, the journal is positioned above the 90th percentile.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-12-15:

WoS: 2
Europe PMC: 2

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Azerbaijan; Bulgaria; Croatia; Czech Republic; France; Germany; Greece; Israel; Italy; Latvia; Lithuania; Norway; Portugal; Russia; Serbia; Slovenia; Switzerland; Ukraine; United Kingdom.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Bladé Creixenti, Joan) .

Awards linked to the item

We thank the Spanish Association of Gastroenterology (AEG) for providing the e-CRF service free of charge.

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Impact on the Sustainable Development Goals (SDGs)

Analysis of institutional authors

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