Biological adhesion materials are usually hydrophilic gel polymers containing a multitude of hydrogen bonding groups including carboxy and hydroxyl groups (Wang et al., 2019). The most prevalent polymeric materials utilized for biological adhesion of gastric mucus are chitosan and its derivatives, wheat soluble protein, Polyalkylcyanoacrylate, etc. (Qu et al., 2018). Among mucosal adhesion polymers, deacetylated chitosan is intriguing due to its biodegradability, biological adhesion, and ability to enhance the uptake of active macromolecules (Hejazi and Amiji, 2003). The -NH2 group of chitosan and its derivatives is protonated at the acidic pH of gastric juice and establishes electrostatic interactions with negatively charged gastric mucin and bacterial membranes, thereby exhibiting adhesion properties, and consequently has been developed recurrently for gastric applications (Chaves de Souza et al., 2020; Lang et al., 2020). The lipophilic amino acid residues of maltolysin are capable of interacting with biological tissues, while maltolysin nanoparticles are susceptible to aggregation by pH, temperature, and salt, thus achieving their adhesion properties (Arangoa et al., 2000).

In the recent decade, chitosan nanoparticles or biologically modified materials have been gradually found to be combined with loaded drugs to prolong drug delivery through bioadhesion (Gonçalves et al., 2014). The reacetylated chitosan microspheres developed and optimized by Portero et al. (2002) exhibited controlled water solubility and gelation at acidic pH, leading to prolonged release of encapsulated anti-H. pylori drugs. It was revealed that the time of reacetylation is a major factor affecting the drug release and the encapsulation efficiency and antimicrobial activity of the encapsulated compounds. These similar experiments provide a certain foundation for future design optimization of chitosan biomaterials. The in vivo and in vitro experiments of chitosan nanoparticles against H. pylori designed by Luo’s team demonstrated that the anti-H. pylori effect of chitosan (CS) nanoparticles solution was negatively correlated with pH when pH was 4–6. Moreover, this work revealed that the anti-H. pylori effect of 88.5% deacetylated (DD88.5) CS NPs and 95% deacetylated (DD95) CS NPs was 55 and 75%, respectively. A more in-depth study was conducted by Chang et al. (2020) They observed that at pH 2.0, 4,000 g/ml DD95 suppressed the urease activity of H. pylori by 37.86 to 46.53%. In the presence of 50 g/mL of the antibiotics amoxicillin, tetracycline, or metronidazole at pH 6.0 and pH 2.0, H. pylori counts decreased by 1.51–3.19 and 1.47–2.82 Log CFU/mL, respectively, while the addition of the same dose and concentration of DD95 under the same conditions strongly depressed the total H. pylori counts by 3.67–7.61 and 6.61–6.70 Log CFU/mL. With the loading of antibiotics such as tetracycline and metronidazole, the delivery system suppressed the adhesion of H. pylori to cells, thereby promoting the eradication rate of H. pylori. Therefore, biological adhesion materials are promising carriers for the controlled delivery of antimicrobial agents to the gastric cavity and therefore for the eradication of H. pylori, a pathogen closely associated with gastric ulcers and possibly gastric cancer.

Given that H. pylori are colonized under the mucus layer, mucus-penetrating agents facilitate drug delivery to the site of infection and thus enhance eradication rates (Chmiela and Kupcinskas, 2019). Depending on the properties of mucin, a major component of mucus, it is assumed that nanoparticles with hydrophilic, negatively charged surfaces and small particle sizes are capable of effectively penetrating the mucus layer (Nogueira et al., 2013). Previous research has established that positively charged chitosan nanoparticles facilitate mucosal penetration. However, Zhang et al. (2018) designed a biomaterial in which nanoparticles were electrostatically self-assembled with antigen and cell-penetrating peptide (CPP) and then coated with a “mucus-inert” PEG derivative that gradually dissociated from the nanoparticles in the mucus, exposing the CPP-rich core and thus enabling penetration. The experiment results demonstrated that the nanoparticles overcome the mucus barrier for active drug delivery after oral administration. Compared with the positively charged chitosan nanoparticles, the PEG-modified nanoparticles weakened the interaction with mucin and could effectively penetrate the mucus layer to reach the infection site, which further strengthened the elimination rate of H. pylori. Consequently, the whole material reduces the contact with gastric mucin and also achieves the effect of drug delivery by osmosis.

In addition to the construction of nanoparticles with a hydrophilic surface, negative charge, and small particle size, the applied magnetic field is capable of facilitating the effective penetration of the drug delivery system into the gastric mucus layer and reaching the site of H. pylori infection (Silva et al., 2009). For instance, Chitosan/polyacrylic acid particles co-loaded with superparamagnetic iron oxide nanoparticles and amoxicillin prepared by Yang et al. (2020) were employed as drug nanocarriers for H. pylori eradication therapy. The nanocarriers noticeably enhanced the penetration into the gastric mucus layer and improved the eradication of H. pylori when exposed to an applied magnetic field. The results showed that all the nanoparticles accumulated at the bottom of the mucus layer after 10 min of the applied magnetic field, indicating that the mucus penetration efficiency of the prepared magnetic nanoparticles could be controlled by the applied magnetic field. Similarly, Walker et al. (2015) prepared a magnetic microhelix system with immobilized urease on the surface by simulating the movement of H. pylori through the gastric mucus layer. The results exhibited that the applied magnetic field allowed the system to advance efficiently in the gastric mucus layer, while the surface-immobilized urease significantly promoted the mobility of the microparticles. Therefore, these nanocarriers prolong the residence time of the drug in the stomach, reducing the drug dose and treatment time required for H. pylori eradication therapy.

Among the dwelling drug delivery systems, the floating raft system achieves drug gastric retention by floating on the gastric contents for prolonged drug delivery as a result of its low density and has been evaluated for maintaining drug delivery and targeting (Thombre and Gide, 2016). Conway’s group (Adebisi et al., 2015) developed calcium alginate microspheres by ionic gelation and modified them with chitosan and oil to optimize float ability, adhesion, and drug release. The experimental results revealed that the floating beads remained for at least 24 h. More than 75% of the beads were adherent to the gastric mucosa for more than 8 h and guaranteed drug release, indicating the fresh dosage form ensures better retention time in the stomach than the convention. Additionally, Rajinikanth et al. (2007) demonstrated the feasibility of prolonging the gastric residence time and release rate of metronidazole utilizing an FRS prepared from ion-sensitive in situ gels. FRS consists of sodium alginate and gellan gum, sodium citrate and calcium carbonate, and lipids. Release kinetic studies of the selected formulation revealed that FRS had a short-term gelation lag time (3 s) and a duration of up to 24 h, with a reliable slow release of the drug. The refined properties of the selected FRS make it an excellent candidate for gastric-targeted eradication of H. pylori.

The protracted administration of PPI is prone to side effects involving osteoporosis, vitamin C deficiency, etc. (Pouwels et al., 2011; Heidelbaugh, 2013). Nevertheless, bio-inspired design principles and advances in nanomaterials have generated significant advances in the field of intra-gastrointestinal drug delivery, especially in nano/micro motors, which are essentially chemically neutralized to modulate the harsh acidic environment to neutral and avoid reducing the efficacy of the drug. Micromotors commonly refer to chemically driven nanomotors, which are small devices facilitated by catalytic reactions in liquids (Sánchez et al., 2015). Artificial micromotors enable self-propulsion in the stomach, enhanced retention of intestinal fluid in the gastric mucosal layer, and targeted delivery in the gastrointestinal tract. Walker et al. (2015) demonstrated the ability of magnetic micro propellers to move through gastric mucus gel by simulating the mucus permeation strategy of H. pylori.

In regard to eradicating H. pylori, Wu et al. (2021) report a nanomotor that allows small molecules of clarithromycin, calcium peroxide nanoparticles (CaO₂) and platinum nanoparticles to be loaded into the motor via ultrasound. The nanomotor can rapidly consume gastric acid and temporarily neutralize gastric acid by the chemical reaction of CaO₂. The reaction of CaO2 with gastric juice has been demonstrated by in vivo experiments to result in rapid consumption of protons, thereby temporarily neutralizing acid without affecting normal gastric function. In particular, the acid-driven nanomotors can be effectively loaded with antimicrobial drugs and exhibit prominent bactericidal activity. Similarly, Wang et al. (de Ávila et al. 2017) experimented with the efficient propulsion of magnesium-based micromotors in an acidic gastric environment. Upon temporary depletion of gastric acid, they were actively and persistently retained in the gastric mucosa. The experimental results illustrate that acid-driven magnesium-based micromotors efficiently load clinical doses of drugs and exert significant H. pylori eradication capabilities. These conclusions implicate the nanomotor as a promising alternative to PPI in H. pylori eradication.

Magnetic drug delivery particle carriers are a tremendously effective modality for delivering drugs to localized disease sites in the gastrointestinal tract. The speed of passage through the GI tract can be slowed down at specific locations by external magnets, thus altering the time and extent of drug absorption in the stomach or intestines (Häfeli, 2004). Furthermore, Thamphiwatana et al. (2013) attached chitosan-modified gold nanoparticles to the outer surface of doxycycline-loaded anionic liposomes. Under a gastric acidic environment, the gold nanoparticles spontaneously bound to the surface of the anionic liposomes by the mutual attraction of heterogeneous charges, which effectively delayed the drug release. Once the neutral pH environment was reached, the surface charge of gold nanoparticles was reduced to detach from the liposomes, exposing the drug-loaded liposomes, which released the drug by fusing with H. pylori cell membranes. Compared with free doxycycline, the gold nanoparticle-encapsulated liposomes displayed a stronger antibacterial effect against H. pylori.

With multidisciplinary cross-fertilization, Yang et al. (2014) Chitosan/polyacrylic acid particles physically co-loaded with superparamagnetic iron oxide nanoparticles and amoxicillin (SPIO/AMO@PAA/CHI) were used as drug nanocarriers for H. pylori eradication therapy. In vitro and in vivo results showed that the designed SPIO/AMO@PAA/CHI nanoparticles were biocompatible and could retain the biofilm inhibitory and bactericidal effects of amoxicillin against H. pylori. In addition, the mucosal adhesion properties of chitosan allow SPIO/AMO/PAA/CHI nanoparticles to adhere to the gastric mucus layer and to rapidly cross the mucus layer after exposure to a magnetic field. Consequently, the application of this nanocarrier allows for prolonged drug residence time in the stomach, reduced drug doses, and treatment cycles for H. pylori eradication therapy (Yun et al., 2015).

pH-sensitive specific materials hold promising prospects for a widespread application in anti-H. pylori drug delivery systems. Su et al. (2016) synthesized a poly (glutamic acid-arginine) complex peptide, which exhibited different morphologies in different pH environments to control drug release. At pH 2.5, the nanoparticles formed by peptide self-assembly were dense and intact spheres with little release of amoxicillin. The peptide nanoparticles exhibited a diffuse state when pH 7.0, therefore contributing to the steady release of amoxicillin. Furthermore, Jing et al. (2016) designed and synthesized a pH-response drug delivery system against H. pylori using UCCs/TPP nanoparticles encapsulated with amoxicillin. The results showed that the amoxicillin- UCCs /TPP nanoparticles had superior PH-sensitivity and could delay the release of amoxicillin in gastric acid, enabling the effective delivery and targeting of the drug to the survival region of H. pylori. The protective effect of these bio-nanoparticles on amoxicillin and the controlled release resulted in the inhibition of H. pylori growth about 5.1 times higher than that of single amoxicillin.

In a further breakthrough, low molecular weight rockrose gums/CS-N-Arg NPs have been developed (Lin et al., 2017). The NPs were further cross-linked with genipin to obtain pH-responsive nanogels. Ultimately, they were found to exert inhibitory effects on H. pylori adherence and preventive effects on pathogen-induced gastric epithelial cytotoxicity. Recently, Yan et al. (2021) report a pH-responsive persistent luminescence enzyme for in vivo imaging and inactivation of H. pylori. The persistent luminescence enzyme, composed of mesoporous silica-coated sustained luminescence nanoparticles, Au nanoparticles, and chitosan-benzoic acid, exhibits good resistance to gastric acid corrosion and exhibiting pH-activated dual-nano activity, thereby catalyzing the performance of bactericidal reactive oxygen species.

The urea transport channel protein (Urel) is one of the most essential factors for the survival of H. pylori in the stomach, as it modulates the opening and closing state according to the pH value of the stomach (Cui et al., 2019). UreI is utilized as a target for delivering drugs to block the transport of urea and disrupt the survival environment of H. pylori so as to make it fail to colonize the gastric mucosa, thereby achieving the eradication of H. pylori. Building on the UreI-mediated targeted drug delivery system, scientists have invented biological nanomaterials for the specific eradication of H. pylori. Luo et al. (2018) reported that ureido-conjugated chitosan showed the ability to target UreI specifically expressed by H. pylori. The ability of the drug delivery system constructed on the basis to eliminate H. pylori was significantly enhanced. Analogously, Cong et al. (2019) coupled carboxymethyl chitosan modified with stearic acid to urea and presented exceptional H. pylori targeting and anti-H. pylori efficacy as well.

Photo-responsive therapy, a therapeutic technique in which a photosensitizer oxidizes biomolecules and causes irreversible damage by generating reactive oxygen species under laser irradiation, has attracted increasing attention as a promising strategy for eliminating bacteria (Huang et al., 2012; Jeong et al., 2014). To develop a photo-responsive H. pylori-based therapeutic regimen, Na et al. (Im et al., 2021) proposed a photo-responsive system targeting H. pylori consisting of multiple 3′-sialoyl lactose (3SL)-coupled poly (l-lysine)-based photosensitizers (p3SLP). P3SLP achieves specific delivery of H. pylori-based drugs through the specificity between 3SL and sialic acid-binding adhesin (SabA) on the membrane of H. pylori interaction to achieve specific H. pylori-based drug delivery (Garcez et al., 2010). This is principally attributed to the fact that one of the outer membrane proteins of H. pylori is sialic acid-binding adhesin (SabA), while the 3SL receptor is not expressed in mammalian cells thus avoiding undesirable phototoxicity to normal cells (Ling et al., 2012). The authors’ gastrointestinal assays in H. pylori-infected mice exhibited that the photo-responsive system had a pronounced H. pylori-specific antibacterial effect with no side effects on normal tissues. Additionally, an anti-inflammatory response was observed at the site of infection following p3SLP treatment. Although the clinical application of photo-responsive treatment of H. pylori is still an underdeveloped field, this approach does not contribute to adverse drug resistance compared to conventional antibiotic-based treatment (Demidova and Hamblin, 2004; Dai et al., 2009). However, the specific wavelength of laser light required for a particular type of photosensitizer varies from one to another. Therefore, we can continuously explore more photosensitizers to improve the potential of photosensitization therapy for H. pylori eradication (Park et al., 2016).

Liposomes (LPs) LPs are defined as lipid vesicles composed of one or more phospholipid bilayers, with spherical shapes and sizes between 25 and 1,000 nm. They can encapsulate lipophilic and hydrophilic drugs in lipid membranes and aqueous cores, respectively. LPs show many advantages, such as the flexibility to change their chemical composition and, moreover, allow for surface functionalization or targeted delivery. Considering the cell membrane-like structure of LPs, they exhibit good biocompatibility, low toxicity, etc. Thamphiwatana et al. (2013) evaluated the activity of LPs containing integrated linolenic acid (LLA), naming the system LipoLLA, against H. pylori. Several free fatty acids, including LLA, have been investigated as new drugs because of their antibacterial activity against various bacteria. In this study, fusion with bacteria was confirmed by a lipophilic fluorophore label, illustrating that LipoLLA was able to cause some damage to the bacterial membrane.

Recently, Martins’ team employed precrol®ATO5 and Miglyol®812 as lipids and Tween®60 as a surfactant to prepare nanostructured lipid carriers (NLC). Seabra et al. (2018) demonstrated that NLC, even without any drug loading, is capable of destroying H. pylori at low concentrations. NLC is designed to rapidly bind and destroy the H. pylori bacterial film without affecting other bacteria, resulting in bacterial death. This study reveals that NLC is a bright avenue to explore in the quest for innovative antibiotic-free treatments against H. pylori infection.

The application of natural cell membranes in the field of biomimetic nanomedicine has attracted much attention in recent years on account of their prolonged circulation time in vivo and outstanding biocompatibility. For instance, natural cell membranes are encapsulated with nanoparticles in their cores as a shell, thus giving the nanoparticles the biological properties of natural cells. Angsantikul et al. (2018) coated gastric epithelial cell membranes with clarithromycin-loaded polymers, and the nanoparticles preferentially adhered to the surface of H. pylori and presented better therapeutic effects in an in vitro test. In addition to host cell membrane mimicry, pathogenic cell membrane mimicry nanoparticles could interfere with the interaction between pathogenic bacteria and the host. The NPs compete with H. pylori for the binding sites on the host cells and detach the adherent H. pylori, exerting a noteworthy anti-adhesive effect (Zhang et al., 2019). These explorations are proved to be a pioneering choice as a coating material to boost the biocompatibility of drugs, exhibiting properties concerning immune escape, high circulation time, moderating elimination of the reticuloendothelial system, mimics cellular glycocalyx to prevent serum protein adsorption and counteract complement response.

Specially modified phages are available to bind to specific pathogenic bacteria. Aiming to strengthen the antibacterial ability of phages, genetic engineering and chemotherapeutic drug coupling technologies have been established for the modification of phages and drug delivery. Cao et al. (2000) constructed a modified phage M13 to express a shell protein that fused with H. pylori cell membrane surface-specific antigen. The results indicated that the recombinant phage M13 exhibited bactericidal effects and specifically inhibited the growth of six H. pylori strains. Moreover, oral pretreatment with M13 significantly attenuated the colonization of H. pylori in the stomach of mice. Sequentially, Ardekani et al. (2013) successfully exploited an M13 phage-based nanovirus. Through sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting analysis, the nanovirus was confirmed to inhibit urease activity, further disrupting the survival environment of H. pylori. There are few studies on phages against H. pylori, and no studies have been conducted on their application as drug carriers in the field of anti-H. pylori. As the mechanism of phage bactericidal activity is completely different from that of antibacterial drugs, phage therapy is expected to be an attractive approach to addressing the multidrug resistance of H. pylori. However several human gut microbiota research studies have demonstrated that phages perform a function in intestinal homeostasis (Ferreira et al., 2022). Currently, phages are thought to precisely affect the intestinal microbiota and exert beneficial effects on numerous gastrointestinal disorders (Muñoz et al., 2020). However, whether the M13 phages discussed above have a specific impact on the intestinal microbiota still deserves a lot of investigation.

Metal nanoparticles exert antibacterial effects through metal ion release, oxidative stress, and non-oxidative stress (Zaidi et al., 2017). As a result of various antibacterial mechanisms, metal nanoparticles are efficient at low concentrations and not easily induced to develop drug resistance. It was demonstrated that the antibacterial activity of silver nanoparticles not only inhibited the respiratory system and biofilm formation of H. pylori but also directly interfered with the nickel in the urease of H. pylori to inactivate the urease, exerting the antibacterial efficacy (Amin et al., 2012). Sreelakshmi et al. (2011) synthesized silver nanoparticles using Glycyrrhiza glabra root extract, which has known therapeutic activity in the treatment of gastric ulcers. In the agar diffusion test, the nanoparticles showed activity against H. pylori and can be considered a new method to eradicate this bacterium in the treatment of gastric ulcers.

Besides silver, other metals have also been used in the biosynthesis of nanoparticles as an alternative treatment for H. pylori infection. It is worth mentioning that ZnO NPs have been approved and generally recognized as safe for normal cells. Chakraborti et al. (2013) employed polyethyleneimine (PEI) functionalized ZnONPs (ZnO-PEI NPs), which greatly reduced the surface energy of ZnO NPs. The ZnO-PEI NPs were effective against H. pylori metronidazole-resistant strains, and their mechanism of action included promoting the production of intracellular reactive oxygen species and causing cell membrane and RNA damage. Wu et al. (2019) designed bifunctional magnetic nanoparticles placed in a moderate AC magnetic field to locally deposit heat and effectively inhibit the growth and virulence of H. pylori in vitro. The survival rate of H. pylori was reduced to 1/7 and 1/5 after treatment with amoxicillin-loaded metal nanoparticles compared with that of amoxicillin alone or blank metal nanoparticles, respectively. The mechanism may be the damage of the cell membrane and increased penetration of amoxicillin into H. pylori, and thus elevated the deracinating efficiency of drug-resistant strains. In clinical applications and against intestinal microbial infections, pH-sensitive cis-aconitate anhydride-modified anti-H. pylori conjugated gold nanostars synthesized by Zhi et al. (2019). The near-infrared laser photothermal treatment enhanced the bactericidal effect, reduced the emergence of H. pylori drug resistance, and even eradicated drug-resistant strains of H. pylori isolated from clinical patients. Additionally, most patients were eliminated from the body within 7 days after the completion of treatment. Therefore biomaterials do hold a promising clinical translation in the eradication of H. pylori. However, the side effects of metal nanomaterials and their dosages on normal tissues are not well investigated. Kim et al. (2010) evaluated the toxic effects of 30 mg/kg, 125 mg/kg, and 500 mg/kg of silver nanoparticles injected into rats. As a result, rats injected with more than 125 mg/kg of silver nanoparticles exhibited toxic reactions and weight loss in the liver. The team revealed that the minimum dose at which harmful effects were observed and the minimum dose at which adverse effects were observed were determined to be 125 mg/kg and 30 mg/kg, respectively. Accordingly, the tendency of most metal nanoparticles to accumulate in organs such as the kidney (Garcia et al., 2016), liver, lung, and spleen, as well as the under-studied toxicity of metal nanoparticles to gastric cell lines, have limited the use of metal nanoparticles in the treatment of H. pylori.

Bacterial biofilm formation is an overwhelming mechanism of bacterial drug resistance (Chen et al., 2018). Since the discovery of H. pylori biofilm in clinical patients, the problem of drug resistance caused by H. pylori biofilm has become a hot topic of interest. It has been exhibited that natural products containing N-acetylcysteine, polysaccharide sulfate, and curcumin hold the ability to inhibit the formation of H. pylori biofilm, while alginate lyase can eliminate H. pylori biofilm by disrupting the biofilm structure (Bugli et al., 2016). On this foundation, Gurunathan et al. (2015) confirmed that the silver nanoparticles stabilized with N-acylhomoserine lactase significantly inhibited the formation of H. pylori biofilm, which may be related to the inhibition of biofilm population sensing (Gopalakrishnan et al., 2020).

Interestingly, hydrogen therapy has previously been applied to eradicate H. pylori. Wang’s group has presented a pH-responsive metal–organic backbone hydrogen nanoparticle (Pd(H) @ZIF-8). The nanoparticle was wrapped in ascorbyl palmitate hydrogel to target and adhere to the site of inflammation by electrostatic interactions, and thereafter hydrolyzed at the site of inflammation by an enriched matrix metalloproteinase. The released Pd(H) @ZIF-8 nanoparticles are further broken down by gastric acid to produce zinc ions (Zn²⁺) and hydrogen gas, thus effectively disintegrating H. pylori and alleviating inflammation while repairing the damaged gastric mucosa. Unexpectedly, animal experiments have demonstrated that this biomaterial also can avoid intestinal flora dysbiosis, thus providing a more precise, effective, and healthy strategy for the treatment of H. pylori infection (Zhang et al., 2022).

Probiotics are defined as live microorganisms that, when given in sufficient amounts, provide benefits to the host (Chen et al., 2019). Recent investigations have indicated that probiotics are capable of increasing antibiotic activity and may block some resistance mechanisms. For instance, in a meta-analysis, the addition of probiotics to triple therapy was observed to enhance the eradication rate of H. pylori by >12% (Lau et al., 2016). Furthermore, probiotics dramatically minimize the adverse effects of treatment regimens ranging from maintaining intestinal flora homeostasis, moderating inflammation, and diminishing H. pylori adhesion, to elevating the immune response (Lionetti et al., 2010). The antimicrobial, immunomodulatory, and antioxidant properties of lactoferrin increased when it was attached to the surface of bionic nanocrystals (Nocerino et al., 2014). Fulgione et al. (2016) designed a combination material consisting of bionic hydroxyapatite nanoparticles and Lactobacillus paracasei probiotic supernatant based on this efficacy as an alternative therapy for H. pylori infection. The experimental results demonstrated that the supernatant group of lactoferrin (200–600 μg/mL) plus Lactobacillus paracasei had higher antibacterial activity than the conventional antibiotic combination (amoxicillin 200–600 μg/mL, clarithromycin 200–600 μg/mL), even lower levels of pro-inflammatory cytokines such as IFN-γ and higher concentrations of IgG antibodies in the body. This further reveals that probiotics may ameliorate H. pylori-induced gastrointestinal inflammation and improve immunity, thus increasing eradication rates (Lin et al., 2020). Consequently, the combination of probiotics and biomaterials is anticipated to be an attractive approach to drug resistance or adjuvant therapy for H. pylori infection (Chen et al., 2018).