The impact of Helicobacter pylori infection, eradication therapy and probiotic supplementation on gut microenvironment homeostasis: An open-label, randomized clinical trial.

Luyi Chen, Wenli Xu, Allen Lee, Jiamin He, Bixia Huang, Wenfang Zheng, Tingting Su, Sanchuan Lai, Yanqin Long, Hua Chu, Yujia Chen, Lan Wang, Kan Wang, Jianmin Si, Shujie Chen

Journal: EBioMedicine 2019;35():87-96

PMID: 30145102

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Abstract

BACKGROUND

Helicobacter pylori (H. pylori) infection is associated with remodeling of gastric microbiota. However, comprehensive analyses of the impact of H. pylori infection, eradication therapy and probiotic supplementation on gut microbiota are still lacking. We aimed to provide evidence for clinical decision making.

METHODS

Seventy H. pylori-positive and 35 H. pylori-negative patients (group C) were enrolled. H. pylori-positive patients were randomly assigned to group A (14-day bismuth-containing quadruple therapy) and group B (quadruple therapy supplemented with Clostridium butyricum). Stool samples of group A and B were collected on day 0, 14 and 56 while stool samples of group C were collected on day 0. Gut microbiota was investigated by 16S rRNA sequencing.

FINDINGS

The Sobs index (richness estimator) was significantly higher in H. pylori-positive samples than H. pylori-negative samples (p < .05). Several metabolic pathways were more abundant in H. pylori-positive communities while some disease-associated pathways had higher potential in H. pylori-negative community through KEGG pathway analysis. Abundances of most butyrate-producing bacteria significantly decreased, while several detrimental bacteria increased after eradication therapy. Probiotic supplementation was associated with improved gastrointestinal symptoms as well as increased Bacteroidetes:Firmicutes ratio.

INTERPRETATION

While H. pylori infection may not be necessarily detrimental in all patients, eradication of H. pylori was associated with widespread changes in gut microbial ecology and structure. Probiotic supplementation could relieve more gastrointestinal symptoms by inducing alterations in gut microbiota and host immune responses. As such, the decision to eradicate H. pylori should be based on comprehensive analysis of individual patients.

Address: Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China.; Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China; Department of Gastroenterology, Xinchang Hospital of Traditional Chinese Medicine of Zhejiang, Shaoxing, China.; Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.; Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: [email protected].; Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: [email protected].

DOI: 10.1016/j.ebiom.2018.08.028

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MeSH Terms: Adult, Dietary Supplements, Disease Eradication, Female, Follow-Up Studies, Gastrointestinal Microbiome, Helicobacter Infections, Helicobacter pylori, Homeostasis, Humans, Male, Probiotics