{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T19:06:28Z","timestamp":1782759988458,"version":"3.54.5"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T00:00:00Z","timestamp":1713312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background and objective<\/jats:title><jats:p>It remains uncertain if the addition of <jats:italic>Saccharomyces boulardii<\/jats:italic> (<jats:italic>S. boulardii<\/jats:italic>) to bismuth quadruple therapy (BQT) recommended in the current guidelines can enhance the <jats:italic>Helicobacter pylori<\/jats:italic> (<jats:italic>H. pylori<\/jats:italic>) eradication rate and decrease the incidence of adverse events. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to address this issue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed comprehensive searches in PubMed, Embase, Web of Science, and Cochrane library databases from the inception of the databases through to November 1, 2023. A meta-analysis was conducted to determine the pooled relative risk (RR) with 95% confidence intervals (CI) using a random-effects model. We utilized the revised Cochrane Risk of Bias Tool to assess the risk of bias of included studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of six RCTs (1,404 patients) included in this meta-analysis. The results of the intention-to-treat analysis showed that the combination of <jats:italic>S. boulardii<\/jats:italic> with BQT had a higher eradication rate than BQT alone (87.0% versus 83.3%), with a pooled RR of 1.05 (95% CI: 1.00\u20131.10, <jats:italic>p<\/jats:italic> =\u20090.03). In the per-protocol analysis, however, there was no statistical significance between the two groups in the eradication rate (93.7% versus 91.0%, RR\u2009=\u20091.03, 95% CI: 1.00\u20131.06, <jats:italic>p<\/jats:italic> =\u20090.07). The combination of <jats:italic>S. boulardii<\/jats:italic> and BQT had a significantly lower rate of overall adverse events (22% vs. 39%, RR\u2009=\u20090.56, 95% CI: 0.44\u20130.70, <jats:italic>p<\/jats:italic> &amp;lt;\u20090.00001), diarrhea (7.9% vs. 25.7%, RR\u2009=\u20090.29, 95% CI: 0.17\u20130.48, <jats:italic>p<\/jats:italic> &amp;lt;\u20090.00001), constipation (2.9% vs. 8.4%, RR\u2009=\u20090.35, 95% CI: 0.14\u20130.88, <jats:italic>p<\/jats:italic> =\u20090.03) and abdominal distention (4.9% vs. 12.7%, RR\u2009=\u20090.41, 95% CI: 0.23\u20130.72, <jats:italic>p<\/jats:italic> =\u20090.002) than BQT alone. For the assessment of risk of bias, five studies were deemed to have some concerns, while one study was judged to have a low risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Current evidence suggests that supplementation with <jats:italic>S. boulardii<\/jats:italic> in BQT may not have a major effect on the <jats:italic>H. pylori<\/jats:italic> eradication rate, but significantly reduces the incidence of overall adverse events, diarrhea, abdominal distention and constipation. Combining <jats:italic>S. Boulardii<\/jats:italic> with BQT can help alleviate symptoms, potentially improving patient adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p>https:\/\/osf.io\/n9z7c.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1344702","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T05:06:22Z","timestamp":1713330382000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The effect of supplementing with Saccharomyces boulardii on bismuth quadruple therapy for eradicating Helicobacter pylori: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"11","author":[{"given":"Yin","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Teng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Zhong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1186\/s12879-023-08504-5","article-title":"The global prevalence of gastric cancer in Helicobacter pylori-infected individuals: a systematic review and meta-analysis","volume":"23","author":"Shirani","year":"2023","journal-title":"BMC Infect 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