Abstract
Dear Editor,
We read, with great interest, the narrative review by Manfredi et al. 1 suggesting that probiotic strains increased the success rate of Helicobacter pylori eradication therapy in children. They speculated this could be due to the biochemical and immunological effects of the strains or due to an amelioration of adverse effects.
We have previously reported that gastrointestinal adverse reactions reduced the success rate of H. pylori eradication therapy. 2 For example, softening of the stool during eradication therapy was associated with its failure and a substantial proportion of treated subjects complained of abdominal pain and diarrhea, which did not influence medication compliance. We observed significantly looser stool consistency on days 4, 5 and 6 in the eradication failure group compared with the eradication success group, suggesting that the absorption of antibiotics might be affected by diarrhea. The absorption of ionised agents that are poorly lipophilic, such as antibiotics, has been shown to be affected by the small-bowel transit time. 3 Complicating diarrhea can shorten the small-bowel transit time of the drug, reducing its absorption. Since small-bowel transit time is shorter in children than in adults, 4 H. pylori eradication success rates are also lower in children.
We agree that the addition of probiotics to standard triplet therapy, in amounts sufficient to control diarrhea, enhances the H. pylori eradication success rate in children. 5 We are convinced that the abatement of adverse reactions contributes to the success rate, but we cannot deny the involvement of biochemical and immunological mechanism. However, clinically proving it is not easy.
