Authors: Bernhard Sikora , Babak Bahadori , Nikon Moghadasian , Thomas Ambrus , Agnieszka Magg , Babak Malekian , Mohammed H. Moghadasian ,

Abstract

Background: Helicobacter pylori infection is commonly treated with antibiotic-based regimens; however, antimicrobial resistance, treatment failure, and intolerance may limit therapeutic options. Antibiotic-sparing approaches remain investigational but may be considered in carefully selected patients who decline or cannot tolerate conventional therapy.

Case Presentation: We report a 38-year-old woman with recurrent, biopsy-confirmed H. pylori gastritis after failure of two previous antibiotic-based eradication regimens. Because of a family history of gastric cancer, bismuth-containing quadruple therapy was recommended, but the patient declined further antibiotic and bismuth-based treatment owing to concerns about adverse effects. After counseling and written informed consent, she received an off-label, antibiotic-free 14-day regimen consisting of pantoprazole 40 mg, Lacticaseibacillus rhamnosus LCR35, and liquid berberine, administered twice daily in sequence. Symptoms improved during treatment, and no serious adverse effects occurred. Follow-up stool antigen testing approximately nine weeks after therapy was negative. Subsequent gastroscopy approximately twelve weeks after treatment showed discrete gastritis with biliary duodenogastric reflux, and rapid urease testing was negative.

Conclusion: This case suggests that an antibiotic-free combination of proton pump inhibitor, probiotic, and berberine was associated with negative follow-up H. pylori testing in a carefully selected patient who declined standard therapy. The approach should not replace guideline-recommended treatment, but it may warrant further investigation in controlled studies.

Keywords: Helicobacter pylori, Lacticaseibacillus rhamnosus, berberine, probiotic, antibiotic-free.