Saccharomyces boulardii as Adjunctive Therapy in Helicobacter pylori Eradication: A Randomized, Placebo-Controlled Trial.

Adjunctive Saccharomyces boulardii with 14-day P-BAC therapy in Helicobacter pylori-positive adults in Iran did not significantly increase eradication rates (PP 65.0% vs 76.5%).

• Why it matters: In Iran’s high-prevalence, high-antibiotic-resistance setting, adjuncts are sought to improve eradication and reduce treatment intolerance, but prior evidence has been inconsistent.
• What they did: In a randomized, single-blind, placebo-controlled trial of 218 adults, participants received 14 days of PPI, bismuth, amoxicillin, and clarithromycin plus either Saccharomyces boulardii 250 mg twice daily or placebo; eradication was measured 30 days later by stool antigen testing (ITT and PP).
• The result: Eradication was not significantly different in either PP (RR 0.849, 95% CI 0.709–1.018) or ITT (RR 0.867, 95% CI 0.710–1.058), but adverse events were less frequent with Saccharomyces boulardii (44.0% vs 68.4%; P < 0.001), including bloating and epigastric pain.

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