Efficacy and safety of Saccharomyces boulardii as adjunctive therapy in rescue treatment for Helicobacter pylori infection:a systematic review
LIU Yuhao
ZHU Xiaojing
ZHANG Ju
LI Jie
LI Denghua
ZHANG Yanpeng
GUO Qiqi
SHI Yongquan
Abstract：Objective To systematically evaluate the efficacy and safety of Saccharomyces boulardii(S.boulardii)as an adjuvant to rescue regimens for Helicobacter pylori(Hp)infection after initial eradication failure,and to provide evidence for clinical decision-making in retreatment.Methods We searched CNKI,VIP,Wanfang,PubMed,Embase,and Cochrane Library from their inception to November 10,2025 for randomized controlled trials(RCT).Literature was screened according to the preset inclusion and exclusion criteria,data were extracted and quality was evaluated.Statistical analysis was conducted using RevMan 5.4 software.Results Seven RCTs were included,involving 982 adult patients with Hp infection who had experienced at least one eradication failure.Per-protocol analysis showed that the Hp eradication rate was 88.1％(386/438)in the experimental group and 78.4％(331/422)in the control group,with low heterogeneity between the two groups(I2=25％).Under a random-effects model,the addition of.S.boulardii significantly increased the Hp eradication rate[RR=1.11,95％CI(1.03,1.19),P=0.004].In subgroup analyses of both bismuth-containing quadruple therapy and PPI-based triple regimens,the addition of S.boulardii consistently improved eradication rates.In terms of safety,the overall incidence of adverse events was 8.9％(34/384)in the experimental group,lower than 19.0％(72/378)in the control group,and the pooled results indicated a significantly reduced risk of adverse events[RR=0.49,95％CI(0.33,0.71),P=0.000 2].For the outcome of diarrhea,combination therapy with S.boulardii likewise significantly reduced its incidence[1.9％vs 7.6％,RR=0.26,95％CI(0.11,0.63),P=0.003].Sensitivity analyses demonstrated that the main findings were robust,and funnel plots were generally symmetrical,not observing obvious publication bias.Conclusion In patients receiving rescue therapy for Hp infection,adding S.boulardii to guideline-recommended eradication regimens can further improve eradication rates and significantly reduce overall adverse events and antibiotic-associated diarrhea,which is worthy of being popularized.
Keywords：Helicobacter pyloriSaccharomyces boulardiiprobioticstreatment failurerescue therapybismuth-containing quadruple therapysystem evaluationrandomized controlled trials
Publication Date：2026-06-30
Online Publishing Date：2026-08-26(First online date of this platform, not the publication date of the document)
Pages：8( 827-834 )