Objective  To investigate the effects of Bifidobacterium, Lactobacillus and Enterococcus on the intestinal flora and toll-likereceptor4 (TLR4), myeloiddifferentiationfactor-88 (MyD88), nuclear factor-κB (NF-κB) signaling pathways in patients with Helicobacter pylori (Hp)-positive gastric ulcers (GU).

Methods  Patients with Hp-positive GU treated in the Department of Gastroenterology at Jinhua People's Hospital from January 2023 to January 2024 were selected as research subjects. The patients were divided into a conventional group (standard quadruple therapy) and a combination group (Bifidobacterium, Lactobacillus and Enterococcus+standard quadruple therapy). The ulcer healing rate, Hp eradication rate and gastric mucosal damage degree (GMDD) scores were compared between the two groups of patients after treatment. Bacteria (Bifidobacterium, Lactobacillus, Enterobacter, Enterococcus and Clostridium) were identified using the fully automatic rapid microbial identification intelligent analysis system. Serum levels of TLR4, mMyD88, NF- κB and inflammatory cytokine [interleukin-6 (interleukin-6, IL-6), C-reactive protein (C-reactive Protein, CRP), interleukin-8 (interleukin-8, IL- 8) and matrix metalloproteinase-9 (matrix Metalloproteinase-9, MMP-9)] were detected using the enzyme-linked immunosorbent assay (ELISA). Additionally, the occurrence of adverse reactions such as nausea, vomiting, diarrhea, and rash was observed.

Results  A total of 103 patients were included, including 54 in the conventional group and 49 in the combination group. After treatment, the ulcer healing rate and Hp eradication rate of GU patients in the combined group were significantly higher than those in the conventional group (36.73% vs. 16.67%, P<0.05; 68.52%  vs. 85.71%, P<0.05). The GMDD score of GU patients in the combination group was significantly lower than that of the conventional group (P<0.05). After treatment, no significant changes were observed in the intestinal flora of the conventional group (P>0.05). In the combination group, except for Clostridium, the contents of Bifidobacterium, Lactobacillus, Enterobacter and Enterococcus were significantly decreased (P<0.05). After treatment, the serum levels of TLR4, MyD88, NF-κB, IL-6, CRP, IL-8 and MMP-9 in GU patients of the combination group were significantly lower than those in the conventional group (P<0.05). In terms of adverse reactions, the incidence was similar between two groups (P<0.05).

Conclusion  The combivation of Bifidobacterium, Lactobacillus and Enterococcus and the standard quadruple therapy can improve gastric mucosal damage, promote ulcer healing, and increase the Hp eradication rate, which may play a role in regulating inflammatory response by mediating TLR4/MyD88/NF-κB signaling pathways.

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