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Meta-Analysis
. 2019 Oct;17(11):2185-2198.e3.
doi: 10.1016/j.cgh.2019.01.013. Epub 2019 Jan 16.

Association Between Helicobacter pylori Exposure and Decreased Odds of Eosinophilic Esophagitis-A Systematic Review and Meta-analysis

Shailja C Shah  1 , Adam Tepler  2 , Richard M Peek Jr  3 , Jean-Frederic Colombel  4 , Ikuo Hirano  5 , Neeraj Narula  6
Affiliations
Meta-Analysis

Association Between Helicobacter pylori Exposure and Decreased Odds of Eosinophilic Esophagitis-A Systematic Review and Meta-analysis

Shailja C Shah et al. Clin Gastroenterol Hepatol. 2019 Oct.

Abstract

Background & aims: Previous or current infection with Helicobacter pylori (exposure) has been reported to protect against eosinophilic esophagitis (EoE), perhaps owing to H pylori-induced immunomodulation. However, findings vary. We performed a systematic review and meta-analysis of comparative studies to define the association between H pylori exposure and EoE more clearly.

Methods: We searched 4 large databases to identify comparative clinical studies that included sufficient detail to determine the odds or risk of EoE (primary outcome) or esophageal eosinophilia (secondary outcome) among individuals exposed to H pylori (exposed) vs individuals who were tested and found to be unexposed. Estimates were pooled using a random-effects model. Meta-regression and sensitivity analyses were planned a priori. Studies were evaluated for quality, risk of bias, publication bias, and heterogeneity.

Results: We analyzed 11 observational studies comprising data on 377,795 individuals worldwide. H pylori exposure vs nonexposure was associated with a 37% reduction in odds of EoE (odds ratio, 0.63; 95% CI, 0.51-0.78) and a 38% reduction in odds of esophageal eosinophilia (odds ratio, 0.62; 95% CI, 0.52-0.76). Fewer prospective studies found a significant association between H pylori exposure and EoE (P = .06) than retrospective studies. Effect estimates were not affected by study location, whether the studies were performed in pediatric or adult populations, time period (before vs after 2007), or prevalence of H pylori in the study population.

Conclusions: In a comprehensive meta-analysis, we found evidence for a significant association between H pylori exposure and reduced odds of EoE. Studies are needed to determine the mechanisms of this association.

Keywords: Allergy; Bacteria; Digestive System; Immune System Diseases.

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Conflict of interest statement

Disclosures/conflict of interest statement: The authors have no potential conflicts (financial, professional, nor personal) that are relevant to this manuscript.

Figures

Figure 1:
Figure 1:
PRISMA diagram of study selection
Figure 2:
Figure 2:
Odds of eosinophilic esophagitis in H pylori exposed versus non-exposed individuals
Figure 3:
Figure 3:
Odds of eosinophilic esophagitis or esophageal eosinophilia in H pylori exposed versus non-exposed individuals, pooled odds ratio
Figure 4:
Figure 4:
Meta-regression analysis showing the difference in effect estimates between prospective and retrospective study designs, with prospective studies less likely to show an association between H pylori exposure and eosinophilic esophagitis
See this image and copyright information in PMC

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