Adjunctive probiotics may reduce adverse events during vonoprazan-based Helicobacter pylori eradication: a systematic review and meta-analysis
- 1Department of Pharmacy, Ya’an Yucheng District People’s Hospital (Second People’s Hospital of Ya’an City)
- 2Department of Pharmacy, Sichuan Provincial Maternity and Child Healthcare Hospital and the Affiliated Women’s and Children’s Hospital of Chengdu Medical College
Abstract
Background: Vonoprazan is pharmacologically distinct from proton pump inhibitors and is increasingly incorporated into Helicobacter pylori eradication regimens. Previous meta-analyses of probiotic adjuncts pooled heterogeneous acid-suppressive agents, antibiotic backbones, probiotic products, and treatment durations, limiting inference about the incremental effect of probiotics when the vonoprazan-based regimen is otherwise fixed.
Objective: To determine whether adjunctive probiotics improve tolerability and eradication outcomes when randomized groups receive an otherwise identical vonoprazan-based H. pylori regimen.
Methods: We searched eight bibliographic databases and three trial registries from inception through 15 July 2026. Eligible studies were randomized trials in adults comparing an identical vonoprazan-based regimen with or without concurrently administered probiotics. Risk ratios were pooled using restricted maximum-likelihood random-effects models with Hartung-Knapp confidence intervals. We also reported 95% prediction intervals, absolute effects, outcome-specific RoB 2 assessments, sensitivity analyses, and GRADE certainty ratings.
Results: Nine studies involving 1,270 participants were included. Adjunctive probiotics reduced overall adverse events (5 studies, 611 participants; RR = 0.30, 95%CI: 0.17–0.53; P = 0.004; I ² = 0%; 95% prediction interval: 0.12–0.79), corresponding to 182 fewer affected participants per 1,000 treated (moderate-certainty evidence). Intention-to-treat eradication was slightly higher with probiotics (7 studies, 910 participants; RR = 1.09, 95% CI: 1.00–1.19; I ² = 47.8%), but the prediction interval crossed the null and sensitivity analyses were not statistically significant. Per-protocol eradication showed little or no difference (5 studies, 698 participants; RR = 1.03, 95%CI: 0.97–1.09), and good adherence was not clearly improved.
Conclusion: Among Chinese adults, adjunctive probiotics probably reduce overall adverse events during vonoprazan-based H. pylori eradication therapy. The available evidence does not establish a reliable improvement in eradication success, and applicability to populations outside China remains uncertain.
PROSPERO Registration: CRD420261450405.
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BibTeX
@article{lin2026adjunctive,
title = {{Adjunctive probiotics may reduce adverse events during vonoprazan-based Helicobacter pylori eradication: a systematic review and meta-analysis}},
author = {Chun-Jiang Lin and Peng-Yuan Ren and Hong-Yu Chen and Ming-Qiao Zheng and Yong-Xian Jiang and Gen Li and Min Fu and Ya-Hui Guo},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1946885},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1946885/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adjunctive probiotics may reduce adverse events during vonoprazan-based Helicobacter pylori eradication: a systematic review and meta-analysis
AU - Chun-Jiang Lin
AU - Peng-Yuan Ren
AU - Hong-Yu Chen
AU - Ming-Qiao Zheng
AU - Yong-Xian Jiang
AU - Gen Li
AU - Min Fu
AU - Ya-Hui Guo
PY - 2026
DA - 2026/10/19
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1946885
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1946885/full
AB - Background: Vonoprazan is pharmacologically distinct from proton pump inhibitors and is increasingly incorporated into Helicobacter pylori eradication regimens. Previous meta-analyses of probiotic adjuncts pooled heterogeneous acid-suppressive agents, antibiotic backbones, probiotic products, and treatment durations, limiting inference about the incremental effect of probiotics when the vonoprazan-based regimen is otherwise fixed. Objective: To determine whether adjunctive probiotics improve tolerability and eradication outcomes when randomized groups receive an otherwise identical vonoprazan-based H. pylori regimen. Methods: We searched eight bibliographic databases and three trial registries from inception through 15 July 2026. Eligible studies were randomized trials in adults comparing an identical vonoprazan-based regimen with or without concurrently administered probiotics. Risk ratios were pooled using restricted maximum-likelihood random-effects models with Hartung-Knapp confidence intervals. We also reported 95% prediction intervals, absolute effects, outcome-specific RoB 2 assessments, sensitivity analyses, and GRADE certainty ratings. Results: Nine studies involving 1,270 participants were included. Adjunctive probiotics reduced overall adverse events (5 studies, 611 participants; RR = 0.30, 95%CI: 0.17–0.53; P = 0.004; I ² = 0%; 95% prediction interval: 0.12–0.79), corresponding to 182 fewer affected participants per 1,000 treated (moderate-certainty evidence). Intention-to-treat eradication was slightly higher with probiotics (7 studies, 910 participants; RR = 1.09, 95% CI: 1.00–1.19; I ² = 47.8%), but the prediction interval crossed the null and sensitivity analyses were not statistically significant. Per-protocol eradication showed little or no difference (5 studies, 698 participants; RR = 1.03, 95%CI: 0.97–1.09), and good adherence was not clearly improved. Conclusion: Among Chinese adults, adjunctive probiotics probably reduce overall adverse events during vonoprazan-based H. pylori eradication therapy. The available evidence does not establish a reliable improvement in eradication success, and applicability to populations outside China remains uncertain. PROSPERO Registration: CRD420261450405.
SN - 1663-9812
ER -