Strain-specific efficacy of Limosilactobacillus reuteri DSM 17648 in Helicobacter pylori: eradication therapy: A systematic review and meta-analysis

Introduction. The declining efficacy of the standard regimens for the eradication of Helicobacter pylori ( H. pylori ) and the development of adverse events when prescribed antibacterial therapy substantiates the search for strain-specific adjuvant approaches that can improve the tolerability and efficacy of treatments. Aim. To systematize data on the effect of Limosilactobacillus reuteri ( L. reuteri ) DSM 17648 on the efficacy and safety of H. pylori eradication therapy. Materials and methods. In accordance with PRISMA 2020 statement, a comprehensive literature search was conducted using MEDLINE/PubMed, Embase, Cochrane Library, Scopus, and the Russian Science Citation Index (RSCI) to identify relevant studies published between January 1, 2007 and March 10, 2026. The systematic review and meta-analysis protocol was entered into the PROSPERO database (CRD420261355068). The meta-analysis included the studies of L. reuteri DSM 17648 used as an adjuvant treatment to the standard eradication therapy, as well as studies exploring its effect on H. pylori bacterial load. Results. Ten studies were included; the analysis of the efficacy of adjuvant therapy included seven comparative studies involving 1,217 patients. There was a significant increase in eradication efficacy as compared with the control group when L. reuteri DSM 17648 was given as part of H. pylori therapy (RR 1.088, 95% CI: 1.029–1.150; p = 0.003). The eradication rate was 93.6% versus 83.5% in the control group. The L. reuteri DSM 17648 group demonstrated a lower overall rate of incidence adverse events (RR 0.708, 95% CI: 0.591–0.850; p < 0.001), including the risk of diarrhea (RR 0.586, 95% CI: 0.387–0.886; p = 0.011). A separate analysis showed that the groups receiving L. reuteri DSM 17648 had a significant reduction in bacterial load as measured by the 13C-urea breath test (standardized mean difference: -0.416, 95% CI -0.749 to -0.083; p = 0.014). Conclusions. This strain-specific systematic review and meta-analysis demonstrated that supplementation of L. reuteri DSM 17648 to H. pylori treatment regimens was associated with higher eradication efficacy and an improved safety profile.