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Pretreatment with Lactobacillus- and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy ^1,2,3

¹ From the Departments of Internal Medicine (B-SS, H-CC, and A-WK), Pathology (H-BY), and Medical Technology (J-JW), the Institute of Public Health (S-TW), and the Institute of Clinical Medicine (B-SS, H-CC, and Y-JY), Medical College, National Cheng Kung University, Tainan, Taiwan

Background: Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) can suppress Helicobacter pylori. Improvement of the eradication rate by quadruple therapy of residual H. pylori after failed triple therapy is needed.

Objective: We tested whether prior treatment with AB-yogurt improved the efficacy of quadruple therapy in eradicating residual H. pylori after failed triple therapy.

Design: One hundred thirty-eight patients in whom triple therapy failed were enrolled for a culture study of H. pylori to assess antimicrobial resistance. These patients were then randomly assigned in equal numbers to either a yogurt-plus-quadruple therapy group or a quadruple therapy-only group. The patients received 1 wk of quadruple therapy with or without a 4-wk pretreatment with AB-yogurt (400 mL/d). In the yogurt-plus-quadruple group, excessive ¹³CO₂/mL values of the ¹³C-urea breath test were collected before and every 2 wk during the 4-wk ingestion of yogurt. For both groups, a ¹³C-urea breath test was conducted 6 wk after the quadruple therapy to assess the outcome of residual H. pylori eradication.

Results: For the patients in the yogurt-plus-quadruple therapy group infected with either antibiotic-sensitive or -resistant H. pylori, the excessive ¹³CO₂/mL values of the ¹³C-urea breath test were significantly decreased after the 4-wk ingestion of AB-yogurt (P < 0.0001). The yogurt-plus-quadruple therapy group had a higher H. pylori eradication rate than did the quadruple therapy-only group (intention-to-treat analysis: 85% compared with 71.1%, P < 0.05; per-protocol analysis: 90.8% compared with 76.6%, P < 0.05).

Conclusion: A 4-wk pretreatment with AB-yogurt can decrease H. pylori loads despite antimicrobial resistance, thus improving the efficacy of quadruple therapy in eradicating residual H. pylori.

Key Words: Helicobacter pylori • triple therapy • quadruple therapy • Lactobacillus • Bifidobacterium • yogurt