Can Probiotics Help with H. pylori? A Nutritionist Reviews the Scientific Evidence for Pylopass™ (DSM 17648)

This article is based on the "White Paper on Lactobacillus reuteri DSM 17648 and Helicobacter pylori" jointly published by Novozymes OneHealth and Hot-Heart Gut Academy, as well as multiple peer-reviewed clinical studies. It aims to explain this probiotic strain, which has been studied for over a decade, in an easy-to-understand manner. The following content is for educational information sharing and is not medical advice, nor can it replace a doctor's diagnosis and treatment.

Half the World's Population May Have It in Their Stomachs

Helicobacter pylori (Hp) is a bacterium that can survive in acidic stomach environments. Approximately half of the global population may carry this bacterium in their stomachs^[1]. In Taiwan and Chinese cities, the infection rate is about one in three people; in rural areas, due to differences in hygiene conditions and dietary habits, the proportion may be even higher, close to 40-50%^[1][2].

Unusually, Hp infection often has no obvious symptoms in its early stages. Many people only discover they have been infected for some time after experiencing persistent stomach pain, indigestion, acid reflux, or bad breath. The International Agency for Research on Cancer (IARC), under the World Health Organization, classified Hp as a Group 1 biological carcinogen in 1994^[1]. In 2021, the US Department of Health and Human Services also listed chronic Hp infection as a definite carcinogen in its latest Report on Carcinogens^[1]. This is why multiple international consensus guidelines recommend that Hp-positive individuals consider treatment^[1].

Traditional Antibiotic Therapy Faces Resistance Challenges

The current mainstream approach to eradicating Hp is triple or quadruple therapy, which involves a proton pump inhibitor (PPI) combined with two or more antibiotics. This method has been used for nearly 30 years, but in recent years, with increasing antibiotic resistance, the success rate of eradication has been declining annually – some clarithromycin-containing triple therapies even have eradication rates below the internationally accepted 80% threshold^[1].

At the same time, common side effects of antibiotic treatment include altered taste, diarrhea, nausea, and abdominal pain. A study involving 22,000 patients showed that about 23% experienced at least one adverse reaction during eradication therapy^[1]. The more pronounced the side effects, the lower patients' adherence to medication tends to be, making "effective eradication that is also well-tolerated" a persistent challenge in clinical practice.

Not Killing Bacteria, But "Carrying Them Away" – Understanding the Mechanism of Pylopass™ (DSM 17648)

Against this backdrop, a probiotic strain has been rigorously studied in recent years – Lactobacillus reuteri DSM 17648, marketed as Pylopass™. It was first isolated by a German microbiology research team in 2002 from over 700 Lactobacillus strains due to its unique ability to bind to Hp^[1].

Its mechanism of action differs from the general understanding of "probiotic bacteriostasis": Pylopass™ does not directly kill Hp but actively recognizes and adheres to specific molecular structures on the surface of Hp, quickly forming "coaggregates" – in simple terms, it encapsulates and entwines Hp, preventing Hp from adhering normally to the stomach lining, and ultimately expelling it from the body with gastrointestinal peristalsis^[1].

In vitro experiments show that this binding reaction can occur within seconds, with one Pylopass™ cell binding approximately 2 to 3 Hp cells^[1]. Furthermore, this strain is highly specific; it does not bind to commensal bacteria in the gut (such as E. coli or Streptococcus salivarius) other than Hp and a few related species. Theoretically, it is less likely to disrupt the balance of existing gut microbiota^[1].

It's worth noting that the Pylopass™ product actually uses spray-dried, inactivated bacterial cells. Research has found that the binding ability of this strain comes from its cell surface structure, which remains effective even after inactivation, allowing coaggregation to occur^[1]. This also means it is not affected by stomach acid, does not require live bacteria to survive, and when used in conjunction with antibiotics, its function is not lost due to the bactericidal action of antibiotics, giving it a relative advantage in terms of stability.

So, What Does the Scientific Evidence Say?

Between 2013 and 2021, Pylopass™ completed 12 human clinical trials in 6 countries, including Germany, Ireland, Russia, Romania, China, and India, involving over 950 subjects^[1]. Examining these studies together, several key findings emerge:

When Used Alone, It May Reduce Gastric Hp Load

Multiple placebo-controlled trials have shown that after 2 to 4 weeks of Pylopass™ supplementation alone, subjects' ¹³C urea breath test (UBT, a clinical method for assessing Hp infection severity) values showed a downward trend, and the effect was dose-dependent in some studies – meaning higher doses yielded more significant effects^[3][4][5]. However, some studies also indicated that this reduction was not always statistically significant, requiring larger sample sizes for further validation^[3].

When Used with Triple Antibiotic Therapy, Research Results Are Not Entirely Consistent

This is where the evidence is currently quite divergent. A double-blind trial in India involving 90 people found that the eradication rate for triple therapy plus Pylopass™ was 86.67%, significantly higher than 66.67% for triple therapy alone^[1]. A randomized double-blind trial in China involving 200 people, however, found no significant difference in eradication rates between the Pylopass™ group and the placebo group (approximately 82% vs. 84% in intention-to-treat analysis), but patients in the Pylopass™ group showed more significant improvement in gastrointestinal symptoms and significantly lower incidence of bloating and diarrhea^[6]. The research team hypothesized that this might be related to differences in age distribution, treatment protocols, and other factors between the two regions, reminding us that the efficacy of probiotic adjuncts may vary depending on the population and regimen.

More Consistent Finding: May Reduce Discomfort from Antibiotic Treatment

While studies disagree on whether eradication rates are improved, multiple studies have observed that groups using Pylopass™ concurrently had a relatively lower incidence of common antibiotic side effects such as bloating, diarrhea, and nausea^[6][7]. A Chinese study further analyzed gut microbiota and found that in the Pylopass™ group, the proportion of beneficial bacteria that produce butyrate (such as Faecalibacterium and Subdoligranulum) was higher, while in the placebo group, the proportion of diarrhea-related Escherichia-Shigella genera was significantly higher^[6]. This may partly explain why the Pylopass™ group experienced fewer "gut upsets" during treatment.

Safety Profile

Current cumulative research, with multiple trials focusing on safety indicators such as liver and kidney function, has found no significant abnormalities, indicating a generally good safety record^[3][4]. This strain has also obtained safety qualifications from international bodies such as the European Food Safety Authority (EFSA) (QPS) and the US FDA (GRAS)^[1].

Overall, How Should These Studies Be Interpreted?

Based on existing evidence, a more conservative but relatively objective statement would be:

• Pylopass™ (Lactobacillus reuteri DSM 17648) has demonstrated a unique mechanism of action in in vitro and some human studies, specifically binding to Hp, forming coaggregates, and promoting its excretion, which is relatively unique in the field of probiotics^[1].
• When used alone, it may help reduce gastric Hp load and alleviate mild dyspeptic symptoms, but it is generally not recommended as a substitute for antibiotic eradication therapy, especially for individuals with clear indications for eradication (e.g., peptic ulcers, gastric mucosal atrophy, family history of gastric cancer), who should still prioritize the regular treatment recommended by their doctor^[1].
• As an adjunct to antibiotic therapy, whether it can improve eradication rates is currently not entirely consistent across studies, but in terms of reducing gastrointestinal discomfort during treatment and helping maintain gut microbiota balance, most studies show a consistent direction^[6][7].
• If you do not have an absolute indication for eradication and simply want an additional option besides dietary adjustments, or if you are undergoing antibiotic therapy with your doctor and wish to reduce discomfort during the process, the research on this strain provides a direction for discussion with your doctor.

This field is continuously accumulating larger, more rigorously designed double-blind randomized controlled trials. The current evidence is not yet conclusive, but as a strain with over a decade of research, clear origins, Pylopass™ is a relatively well-documented option in the field of probiotic support for Hp in recent years.

Look for the Trademark: That's the Strain Backed by Clinical Research

It is important to note that "Lactobacillus reuteri" is a species, and there are many different strains on the market, not all of which have undergone Hp-related clinical research. If you wish to use the verified strain mentioned in this article, it is recommended to check whether the ingredient label clearly states Pylopass™ or the strain number DSM 17648, as these are the actual strains used in the studies cited in this article.

I have long focused on European health perspectives and scientific evidence. If you are also interested in topics such as gut health and probiotics, please continue to follow, as I will periodically share more summaries on these subjects.

Currently, Nutrimexx Pylomed, available on Munich Stars, uses the Pylopass™ (DSM 17648) strain. If you are interested in learning about the ingredients and usage, you can click the links below to view the product pages:

This article provides health education information, primarily referencing: Novozymes OneHealth × Hot-Heart Gut Academy "White Paper on Lactobacillus reuteri DSM 17648 and Helicobacter pylori" (2022); Yang C, et al. Helicobacter. 2021; Buckley M, et al. BMC Nutrition. 2018; Mehling H, Busjahn A. Nutrients. 2013; Bordin DS, et al. 2015; Mihai C, et al. Farmacia. 2019. The effects described in the text are mostly from preliminary or small-scale clinical studies. Actual effects vary by individual constitution and may be beneficial for some populations but not applicable to everyone, nor can they replace formal medical diagnosis and treatment. If you experience persistent gastrointestinal discomfort, it is recommended to consult a gastroenterologist for examination and evaluation.