Abstract
Helicobacter pylori may have a protective effect against inflammatory bowel disease (IBD). We integrated epidemiological data to identify the correlation between IBD and H. pylori. Moreover, we analyzed whether IBD medication and classification affect H. pylori, and whether eradication of H. pylori leads to recurrence of IBD. Articles published up to May 1, 2019, in three main databases including PubMed, MEDLINE and Embase, were searched. Study types included cross-sectional studies, retrospective studies and perspective studies, and data were combined and analyzed. Spearman correlation analysis and meta-analysis were performed after collecting and collating the relevant data. Sensitivity analysis and meta-regression were used to evaluate reliability and heterogeneity. Fifty-nine studies on IBD prevalence, 127 studies on H. pylori prevalence, and 23 studies for meta-analysis were included. IBD, ulcerative colitis (UC) and Crohn's disease (CD) were negatively correlated to H. pylori prevalence (all P<0.001). The meta-analysis results showed that compared to controls, the odds of having H. pylori infection were 0.44, 0.36, 0.54 for IBD, CD and UC, respectively (OR=0.44, 95% CI=0.34-0.59; OR=0.36, 95% CI=0.26-0.49; OR=0.54, 95% CI=0.4-0.72). Moreover, IBD patients were 1.41 times (OR=1.41, 95% CI=1.25-1.58) more likely to relapse after eradication of H. pylori. Finally, H. pylori infection was not related to IBD medication and classification. H. pylori prevalence was negatively correlated to IBD and H. pylori had a protective effect against IBD. Furthermore, eradication of H. pylori can lead to recurrence of IBD.
Highlights
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), comprises chronic gastrointestinal disorders characterized by dysregulated intestinal inflammation.[1,2] There are regional differences in the incidence of inflammatory bowel disease (IBD), which is higher in developed countries, while lower in developing countries
The pooling data showed that in North America, Europe, and Oceania, which consist of developed countries, the IBD prevalence was high (378.8/105, 95% CI = 241.5–516/105; 372.6/105, 95% CI = 292.6–452.6/105; 308.6/105, 95% CI = 270.3– 346.9/105, respectively), while the H. pylori prevalence was low (22.5%, 95% CI: = 20.4-24.7%; 36.9%, 95% CI = 32.7–41.2%; 32.9%, 95% CI = 19.4–46.4%, respectively) (Figure 2B)
The IBD prevalence was low (37.6/105, 95% CI = 14.7–60.5/105; 50.6/105, 95% CI = 35.1–66.2/105; 31.6/105, 95% CI = 28.0–35.2/105, respectively), while the H. pylori prevalence was high (63.7%, 95% CI = 52.8–74.6%; 47.8%, 95% CI = 45.1-50.4%; 68.3%, 95% CI = 46.8– 89.7%, respectively) in South America, Asia, and Africa, which are mostly developing countries (Figure 2B)
Summary
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), comprises chronic gastrointestinal disorders characterized by dysregulated intestinal inflammation.[1,2] There are regional differences in the incidence of IBD, which is higher in developed countries, while lower in developing countries. H. pylori infection is closely related to these diseases.[15,16] These two points affected the reliability of the entire meta-analysis to some extent. Helicobacter pylori may have a protective effect against inflammatory bowel disease (IBD). We analyzed whether IBD medication and classification affect H. pylori, and whether eradication of H. pylori leads to recurrence of IBD. IBD, ulcerative colitis (UC) and Crohn’s disease (CD) were negatively correlated to H. pylori prevalence (all P < 0.001).
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