The Relationship between <i> Helicobacter pylori </i>and Inflammatory Bowel Disease Based on Epidemiological Data: A Systematic Review and Meta-Analysis

Abstract

Background: Helicobacter pylori (H. pylori) infection may be a protective effect against inflammatory bowel disease (IBD). The previous meta-analysis was flawed. This study integrated epidemiological data and rearranged a meta-analysis to identify the correlation between IBD and H. pylori. Moreover, whether IBD medication and classification affecting H. pylori infection, and whether H. pylori eradication leading to recurrence of IBD were analyzed in this study. Methods: Articles published until May 1, 2019, in the PubMed, MEDLINE and Embase databases were searched. Spearman correlation analysis and meta-analysis were performed after collecting and collating the relevant data. Sensitivity analysis and meta-regression were used to evaluate the reliability and sources of heterogeneity. Findings: 59 studies of IBD prevalence, 127 studies of H. pylori prevalence, and 23 studies for meta-analysis were included. IBD, Crohn's disease (CD) and ulcerative colitis (UC) was negatively correlated to H. pylori prevalence respectively (p<0.001, p<0.001, p<0.001). In addition, meta-analysis results showed that IBD, CD and UC were 0.44, 0.36, 0.54 times more likely to have H. pylori infection compared to controls (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 H. pylori eradication compared to no H. pylori eradication. Finally, H. pylori infection was not related to IBD medication and classification. Interpretation: H. pylori prevalence was negatively correlated to IBD and H. pylori was a protective effect against IBD. Furthermore, H. pylori eradication can lead to the recurrence of IBD. Funding Statement: This work was supported by the National Natural Science Foundation of China [grant number 81700485, 81600414, 81600447]. Declaration of Interests: The authors declare there is no conflict of interest regarding the publication of this paper. Ethics Approval Statement: The work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.