A lack of benefit of probiotic administration on H. pylori eradication in children was reported in two studies this year. In a randomized, double-blind placebo-controlled trial, Szajewska et al. randomized children receiving 7 days of triple eradication therapy to either supplementation with 109 colony-forming units of Lactobacillus GG
(n = 44) or placebo (n = 39) [53]. Subjects were recruited over a 40-month period, and complete data were only available in 34/44 children in the probiotic group and 32/39 in the placebo group. No statistically significant benefit of probiotic supplementation over placebo was evident in terms of either eradication Cilomilast (69% vs 68%) or side effects. There was a nonsignificant trend toward less regimen-associated diarrhea in probiotic treated children (6% vs 20%), although the study may have been underpowered to detect such differences with significance. In a study using functional food to deliver probiotics (cheese containing Lactobacillus gasseri OLL2716), Boonyaritichaikij et al. studied the effects of probiotic supplementation in two groups of asymptomatic kindergarten children in Thailand – with or without
H. pylori as determined by stool antigen testing (n = 132 and 308, respectively) [54]. The eradication arm of the study was single-blinded and nonrandomized, whereas the prevention arm was randomized and stratified for age and gender. Compliance was evaluated by the children’s teachers. No statistically significant medchemexpress difference was detected between placebo and probiotic treatments in either the eradication or prevention arm 20s Proteasome activity of the study.
The extent of spontaneous clearance of H. pylori infection in childhood remains unclear. The Pasitos cohort study was established in 1998 to prospectively study H. pylori infection in Hispanic children [55]. A recent follow-up report from this study examined the effect of incidental antibiotic exposure on subsequent H. pylori clearance, based on 13C-UBT changes and parental documentation of medication exposure [56]. Medication dose and duration were not recorded. A remarkable 78% of 218 children with a previously positive UBT subsequently tested negative, especially those between ages 1–3. Of the 205 children with complete medication exposure data, 36% received at least one antibiotic course following the initial positive UBT while 68% had a subsequent negative UBT. Notwithstanding the number of significant limitations of this study, incidental antibiotic exposure in this study cohort seemed to account for a relatively limited proportion of ‘spontaneous clearance’ of H. pylori infection. A recent editorial questioned the benefit of eliminating H. pylori, as only 10–15% of hosts develop ulcerations and only 1% gastric adenocarcinoma. Vaccination cannot yet be recommended, as our understanding of the bacteria is too preliminary to make complete eradication a feasible option [57].