Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

210 | P a g e

CNB Scholar Journals

Available online:

www.biology.cnbjournals.com

Journal of Biology and today's world

ISSN 2322-3308

Review Article

Probiotics and Helicobacter pylori

Reza Kazemi Darsanaki

, Morteza Azizollahi Aliabadi

Department of Microbiology, Faculty of Basic Science, Lahijan Branch, Islamic Azad University, Lahijan, Iran

Received: 01 February 2013 / Accepted: 01 March 2013 / Published: 5 May 2013

Copyright © 2013 Reza Kazemi Darsanaki et al. This is an open access article distributed under the Creative Commons

Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original

work is properly cited.

Abstract

Helicobacter pylori infection is a major cause of chronic gastritis and peptic ulcer disease,

and it is also designated as a class-I carcinogen for stomach cancer. The role of probiotics in

the treatment of gastrointestinal infections is increasingly documented as an alternative or

complement to antibiotics, with the potential to decrease the use of antibiotics or reduce their

adverse effects. Probiotics had an in vitro inhibitory effect on H. pylori. Animal studies

demonstrated that probiotic treatment is effective in reducing H. pylori–associated gastric

inflammation. The aim of this review is to consider the current evidence on the effects of

probiotics on human health and eradication Helicobacter pylori.

Keywords: Probiotic, Helicobacter pylori, Infection

1. Introduction

H. pylori infection is recognized as a causative agent for acute and chronic gastritis and as a

predisposing factor to peptic ulcer disease, gastric cancer and gastric lymphoma. This

Correspondence should be addressed to Reza Kazemi Darsanaki, Department of Microbiology, Faculty of

Basic Science, Lahijan Branch, Islamic Azad University, Lahijan, Iran; Email: Reza_kazemi_d@yahoo.com;

Tel: +989335062636.

Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

211 | P a g e

important discovery, rewarded with the 2005 Nobel Prize in Medicine, has changed

gastroenterological practice worldwide since, after its discovery, many gastroduodenal

diseases became curable infectious diseases. The prevalence of H. pylori infection in the

adult population of industrialized countries is estimated to be at 20–50%, and in developing

countries, the rate is as high as 80% [1, 2]. Probiotics can be defined as nonpathogenic

microorganisms that, when ingested, exert a positive influence on the health or physiology of

the host. They consist of either yeast or bacteria, especially lactic acid bacteria. At present,

the most studied probiotics are lactic acid-producing bacteria, particularly Lactobacillus

species. Probiotics have been proven to be useful in the treatment of several gastrointestinal

diseases such as acute infectious diarrhea or pouchitis [3, 4]. The aim of this review is to

consider the current evidence on the effects of probiotics on human health and eradication

Helicobacter pylori.

2. Probiotics

Fermented dairy products and vegetables have been used for thousands of years. As early as

1907, Nobelist Elie Metchnikoff attributed the longevity of Bulgarian peasants to their

consumption of fermented milk products [5]. He suggested that regular consumption of dairy

yogurt may suppress “putrefactive” bacteria in the colon. Since then, several definitions have

been used to describe these probiotics, such as substances that are produced by one

microorganism and stimulate the growth of other microorganisms [6], live microbial feed

supplements that beneficially affect the host animal by improving its intestinal microbial

balance [7], and more recently, live microorganisms that, when administered in adequate

amounts, confer a health benefit on the host [8]. The most commonly used organisms in

probiotic products belongs to Lactobacillus sp., and Bifidobacterium spp., Other organisms

have also been used including Bacillus sp., and yeast such as Saccharomyces boulardii [9,

10]. A probiotic organism should be nonpathogenic and non-toxic, and also resistant to low

pH and to bile salts to improve its chances of survival in the gastrointestinal tract. Probiotics

have been used to treat a wide range of diseases, ailments, and conditions that affect humans

and animals [11]. Probiotics could be used for several conditions such as Diarrhea, Irritable

Bowel Syndrome, Urinary Tract Infections, Immune Disorders, Cancer, Lactose Intolerance,

hyper Cholesterolaemia, Inflammatory Bowel Disease, H. pylori and Allergy [12].

3. Helicobacter pylori

Helicobacter pylori is the first formally recognized bacterial carcinogen and is one of the

most successful human pathogens, as over half of the world's population is colonized with

this gram-negative bacterium. The genus Helicobacter belongs to the subdivision of the

Proteobacteria, order Campylobacterales, family Helicobacteraceae. This family also

includes the genera Wolinella, Flexispira, Sulfurimonas, Thiomicrospira, and Thiovulum [13,

14]. H. pylori seroprevalence is increased with increasing age, lower socioeconomic status

Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

212 | P a g e

and crowdedness in the household, which are probably interrelated factors [15]. H. pylori is a

fastidious microorganism and requires complex growth media. Often these media are

supplemented with blood or serum. Commonly used solid media for routine isolation and

culture of H. pylori consist of Columbia or brucella agar supplemented with either (lysed)

horse or sheep blood or, alternatively, newborn or fetal calf serum. H. pylori is a versatile

organism that produces a wide range of toxins that are detrimental to gastric mucosa both in

vivo and in vitro. These include vacuolating toxin, urease, catalase, phospholipidases, alcohol

dehydrogenase, haemolysin, platelet activating factor and mucolytic factor [16, 17].

4. Probiotics and Helicobacter pylori

In recent years, the development of alternative anti-H. pylori treatments has been actively

pursued, and investigations have been carried out to define components that could be used

either as monotherapy or synergistically in combination with antimicrobials thus resulting in

more effective anti-H. pylori therapy or alternative ways of controlling H. pylori infection.

These novel treatments could potentially reduce the costs related to the treatment of H. pylori

associated diseases. The effect of probiotics on Helicobacter pylori has been studied. Most

evaluations have been done either in laboratory assays or in animal models. These studies

show that antibacterial substances including (but not limited to) organic acids produced by

some lactobacilli inhibit the growth and survival of this pathogen. Results in animal models

demonstrate that some lactobacilli inhibit H. pylori attachment and prevent colonization.

Results in humans show that milk fermented by a Lactobacillus johnsonii strain can help

control H. pylori gastric infections, but cannot eradicate H. pylori from the stomach [18, 19].

In vitro experiments, the effects of administration of the selected Lactobacillus strains on H.

pylori infected mice were examined. Lactobacillus strains were orally administered to H.

pylori infected mice once a week for 8 weeks. One week after the finish of administration of

Lactobacillus strains, the number of H. pylori and serum anti-H. pylori IgG levels were

measured. No H. pylori was detected from Lactobacillus gasseri OLL2716 (LG21) and

Lactobacillus salivarius WB1004 administered mice, and the anti-H. pylori IgG level of

LG21 administrated mice was the lowest. Therefore we selected LG21 as the most suitable

strain for use as a probiotic for H. pylori infection in humans [20]. Mechanisms of inhibition

of H. pylori by probiotics in vitro was shown in table 1. [21]. L. johnsonii La1 and L. gasseri

OLL2716 L. casei Shirota and L. acidophilus have been found to reduce H. pylori

colonization and inflammation [22].

Table 1. Mechanisms of inhibition of H. pylori by probiotics in vitro

Probiotic Mechanism of inhibition

L. acidophilus 4356 Lactic acid

L. casei 393 Lactic acid

L. salivarius WB1040 Lactic acid

L. casei strain Shirota Heat-labile substance

Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

213 | P a g e

L. acidophilus LB Heat-stable protein

L. lactis BH5 Bacteriocin

L. johnsonii La1 Heat-stable substance

L. acidophilus Lactic acid

L. casei subsp. rhamnosus Lactic acid

L. reuteri TM 105 Glycolipid-binding proteins

B. subtilis Anticoumacin A, B,C

L. casei strain Shirota Lactic acid

In study Aiba et al, among the lactobacillus species examined in vitro, Lactobacillus

salivarius but not L. casei or L. acidophilus proved to be capable of producing a high amount

of lactic acid and thus completely inhibiting the growth of H. pylori in a mixed culture [23].

In study Sýkora et al, Supplementation with fermented milk, containing live special probiotic

L. casei DN-114 001, confers an enhanced therapeutic benefit on H. pylori eradication in

children with gastritis on triple therapy [24]. Myllyluoma et al, found, probiotic

supplementation did not diminish significantly the frequency of new or aggravated symptoms

during H. pylori eradication. However, our data suggest an improved tolerance to the

eradication treatment when total symptom severity was taken into account. Furthermore, the

results show that probiotic bacteria are able to survive in the gastrointestinal tract despite the

intensive antimicrobial therapy [25]. In study Ryan et al, Growth inhibition of H. pylori by L.

salivarius is strain-dependent and is not linked to any particular environmental niche or

geographic location. Strains of L. salivarius showing highest anti-H. pylori activity may be

useful as an adjunct in the treatment of strains that are resistant to conventional antibiotics

[26]. Sgouras et al, observed a significant reduction (P=0.046) in H. pylori-induced

interleukin-8 secretion by human adenocarcinoma AGS cells in vitro in the presence of

neutralized (pH: 6.8) Lactobacillus johnsonii La1 spent culture supernatants, without

concomitant loss of H. pylori viability. These observations suggest that during the early

infection stages, administration of La1 can attenuate H. pylori-induced gastritis in vivo,

possibly by reducing proinflammatory chemotactic signals responsible for the recruitment of

lymphocytes and neutrophils in the lamina propria [27].

5. Conclusion Probiotics are found in dairy products, plants, meat products, sewage, manure humans and

animals. These kinds of bacteria have positive effects on immune system by inhibition of

pathogen attachment to epithelial cells, changing the receptor of bacterial toxins, producing

antimicrobial substances such as acid, bacteriocins, fatty acid and aromatic compounds and

competition for food. Atpresence, with increasing of the antibiotic resistance and side effects

of chemical drugs, it seems; we need to use alternative remedies. Probiotics and their

produced metabolites can have therapeutic application in future and eradication H. pylori.

Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

214 | P a g e

References

[1] Go, M., 2002. Natural history and epidemiology of Helicobacter pylori infection. Aliment

Pharmacol Ther., 16: 3-15.

[2] Vaira, D., L. Gatta. C. Ricci. M. Miglioli, 2002. Review article: diagnosis of Helicobacter

pylori infection. Aliment Pharmacol Ther., 16: 16-23.

[3] Rolfe, R.D., 2000. The role of probiotic cultures in the control of gastrointestinal health. J

Nutr., 130: 396–402.

[4] Gill, H.S., F. Guarner, 2004 Probiotics and human health: a clinical perspective. Postgrad

Med J., 80: 516–526.

[5] Metchinkoff, E., 1907. The prolongation of life. Optimistic studies. Butterworth-

Heinemann, London.

[6] Lilly, D.M., R.H. Stillwell, 1965. Probiotics: growth-promoting factors produced by

microorganims. Science., 147: 747-748.

[7] Fuller, R., 1989. Probiotics in man and animals. J Appl Bacteriol., 66:365-378.

[8] FAO/WHO., 2002. Guidelines for the evaluation of probiotics in food. Report of a joint

FAO/WHO working group on drafting quidelines for the evaluation of probiotics in food.

World Health Organization, London Ontario, Canada.

[9] Saxelin, M., S. Tynkkynen, T. Mattila-Sandholm, W.M. de Vos, 2005. Probiotic and other

functional microbes: from markets to mechanisms. Curr Opin Biotechnol., 16: 204-211.

[10] Kazemi Darsanaki, R., K. Issazadeh, M.R.M. Khoshkholgh Pahlaviani and M.

Azizollahi Aliabadi, 2012. Antimutagenic Activity of Lactobacillus spp. Isolated from Fresh

Vegetables against Sodium Azide and 2-Nitrofluorene. J Pure Appl Microbio., 6: 1677-1682.

[11] Kazemi Darsanaki, R., N. Ghaemi, M. Mirpour, F. Mirdavoudi, 2012. Evaluating

Antimutagenic activity of probiotic bacteria isolated from probiotic products. Qom Univ Med

Sci J., 6(2): 37-44.

[12] Zerehpoosh, S., R. Kazemi Darsanaki, 2013. Probiotics and Health. Journal of Biology

and today's world., 2(1): 41-52.

[13] Goodwin, C.S., J.A. Armstrong, T. Chilvers, M. Peters, M.D. Colins, L. Sly, W.

McConnell, and W.E.S. Harper, 1989. Transfer of Campylobacter pylori and Campylobacter

mustelae to Helicobacter gen. nov. as Helicobacter pylori comb. nov. and Helicobacter

mustelae comb. nov., respectively. Int. J. Syst. Bacteriol., 39:397- 405.

Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

215 | P a g e

[14] Fox, J.G., 2002. The non-H. pylori helicobacters: their expanding role in gastrointestinal

and systemic diseases. Gut., 50:273-283.

[15] Kenneth, W.T., L. Shiu-kum, 1999. Helicobacter pylori and extra-digestive diseases.

Journal of Gastroenterology and Hepatology.,14: 844–850.

[16] Peek, R.M., M.J. Blaser, 2002. Helicobacter pylori and gastrointestinal tract

adenocarcinomas. Nat. Rev. Cancer., 2: 28– 37.

[17] Rad, R., Prinz, C., Neu, B., et al, 2003. Synergistic effects of Helicobacter pylori

virulence factors and interleukin-1 polymorphisms for the development of severe histological

changes in the gastric mucosa. J Infect Dis.,188: 272–81.

[18] Gotteland, M., O. Brunser, S. Cruchet, 2006. Systematic review: are probiotics useful in

controlling gastric colonization by Helicobacter pylori? Aliment Pharmacol Ther., 23:1077-

1086.

[19] Hamilton-Miller, J.M., 2003. The role of probiotics in the treatment and prevention of

Helicobacter pylori infection. Int J Antimicrob Agents., 22:360-366.

[20] Sakamoto, I., M. Igarashi, K. Kimura, A. Takagi, T. Miwa, Y. Koga, 2001. Suppressive

effect of Lactobacillus gasseri OLL2716 (LG21) on Helicobacter pylori infection in humans.

J. Antimicrob. Chemother., 47: 709-710.

[21] Lesbros-Pantoflickova, D, I. Corthesy-Theulaz, A.L. Blum, 2007. Helicobacter pylori

and Probiotics. The Journal of Nutrition., 137: 812-818.

[22] Cats, A., E.J. Kulpers., M.A. Bosschaert., R.G. Pot., C.M. Vandenbroucke- Gauls. and

J.G. Kusters, 2003. Effect of frequent consumption of Lactobacillus casei-containing milk

drink in Helicobacter pylori colonised subjects. Pharmacology and Therapeutics., 17: 429–

435.

[23] Aiba, Y., N. Suzuki, A.M. Kabir, A. Takagi, Y. Koga, 1998. Lactic acid-mediated

suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a

probiotic in a gnotobiotic murine model. Am J Gastroenterol., 93(11): 2097-2101.

[24] Sýkora, J., K. Valecková, J. Amlerová, K. Siala, P. Dedek, S. Watkins, J. Varvarovská,

F. Stozický, P. Pazdiora, J. Schwarz, 2005. Effects of a specially designed fermented milk

product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori

in children: a prospective randomized double-blind study. J Clin Gastroenterol., 39(8):692-

698.

Journal of Biology and today's world 2013, volume 2, issue 4, pages: 210-216

216 | P a g e

[25] Myllyluoma, E., L. Veijola, T. Ahlroos, S. Tynkkynen, E. Kankuri, H. Vapaatalo, H.

Rautelin, R. Korpela, 2005. Probiotic supplementation improves tolerance to Helicobacter

pylori eradication therapy a placebo-controlled, double-blind randomized pilot study.

Aliment Pharmacol Ther., 21(10):1263-1272.

[26] Ryan, K,A., P. Daly, Y. Li, C. Hooton, P.W. O'Toole, 2008. Strain-specific inhibition of

Helicobacter pylori by Lactobacillus salivarius and other lactobacilli. J Antimicrob

Chemother., 61(4): 831-834.

[27] Sgouras, D.N., E.G. Panayotopoulou, B. Martinez-Gonzalez, K. Petraki, S.

Michopoulos, A. Mentis, 2005. Lactobacillus johnsonii La1 attenuates Helicobacter pylori-

associated gastritis and reduces levels of proinflammatory chemokines in C57BL/6 mice.

Clin Diagn Lab Immunol., 12(12):1378-1386.