| Summary: | <i>Helicobacter pylori</i> (<i>Hp</i>) eradication therapy alters gut microbiota, provoking gastrointestinal (GI) symptoms that could be improved by probiotics. The study aim was to assess the effect in <i>Hp</i> patients of a Test fermented milk containing yogurt and <i>Lacticaseibacillus</i> (<i>L. paracasei</i> CNCM I-1518 and I-3689, <i>L. rhamnosus</i> CNCM I-3690) strains on antibiotic associated diarrhea (AAD) (primary aim), GI-symptoms, gut microbiota, and metabolites. A randomised, double-blind, controlled trial was performed on 136 adults under 14-day <i>Hp</i> treatment, receiving the Test or Control product for 28 days. AAD and GI-symptoms were reported and feces analysed for relative and quantitative gut microbiome composition, short chain fatty acids (SCFA), and calprotectin concentrations, and viability of ingested strains. No effect of Test product was observed on AAD or GI-symptoms. <i>Hp</i> treatment induced a significant alteration in bacterial and fungal composition, a decrease of bacterial count and alpha-diversity, an increase of <i>Candida</i> and calprotectin, and a decrease of SCFA concentrations. Following <i>Hp</i> treatment, in the Test as compared to Control group, intra-subject beta-diversity distance from baseline was lower (<i>p</i><sub>adj</sub> = 0.02), some <i>Enterobacteriaceae</i>, including <i>Escherichia-Shigella</i> (<i>p</i><sub>adj</sub> = 0.0082) and <i>Klebsiella</i> (<i>p</i><sub>adj</sub> = 0.013), were less abundant, and concentrations of major SCFA (<i>p</i> = 0.035) and valerate (<i>p</i> = 0.045) were higher. Viable <i>Lacticaseibacillus</i> strains were detected during product consumption in feces. Results suggest that, in patients under <i>Hp</i> treatment, the consumption of a multi-strain fermented milk can induce a modest but significant faster recovery of the microbiota composition (beta-diversity) and of SCFA production and limit the increase of potentially pathogenic bacteria.
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