Omeprazole With Probiotics Versus Standard Triple Therapy for Suspected Helicobacter pylori Infection: An Exploratory Day-14 Serological Cohort Study

Background: Helicobacter pylori infection is a major global health concern and a well-established risk factor for chronic gastritis, peptic ulcer disease, and gastric malignancy. Standard triple therapy remains the recommended first-line treatment. Probiotics have emerged as a potential adjunct or alternative strategy due to their role in modulating gut microbiota and reducing treatment-related adverse effects. Objective: This exploratory study aimed to compare the short-term effectiveness and tolerability of Omeprazole combined with Lactobacillus reuteri versus conventional standard triple therapy in adults with suspected H. pylori infection. Methodology: A comparative, non-randomized cohort study was conducted over eight months at a tertiary care hospital in Karachi, Pakistan. A total of 184 adults with peptic ulcer disease and positive H. pylori serology were enrolled. Participants received either conventional triple therapy (Omeprazole, Clarithromycin, and Amoxicillin) or Omeprazole combined with Lactobacillus reuteri for 14 days. H. pylori status was assessed using blood antibody testing at Day 14 as a preliminary indicator of response. Gastrointestinal symptoms were recorded, and data were analyzed using chi-square tests, independent t-tests, and multivariate logistic regression. Results: Participants receiving Omeprazole plus probiotics demonstrated significantly lower Day-14 H. pylori seropositivity compared with those receiving standard triple therapy (27.2% vs 56.5%; p = 0.023). Gastrointestinal adverse effects, including epigastric pain, nausea and vomiting, diarrhea, and constipation, were significantly less frequent in the probiotic group. Adjusted analysis showed reduced odds of persistent seropositivity in the Omeprazole plus probiotics group (adjusted OR = 0.34; 95% CI: 0.18–0.64; p < 0.001). Conclusion: In this exploratory cohort, Omeprazole combined with probiotics was associated with improved short-term serological outcomes and better gastrointestinal tolerability compared to conventional triple therapy. These findings support the need for further randomized controlled trials using validated eradication tests to confirm therapeutic efficacy. Keywords: Helicobacter pylori, Lactobacillus reuteri, Omeprazole, Peptic Ulcer Disease, Probiotics, Triple Therapy.