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Meta-Analysis
. 2019 Jul;50(2):121-131.
doi: 10.1111/apt.15306. Epub 2019 Jun 5.

Systematic review with meta-analysis: association between Helicobacter pylori CagA seropositivity and odds of inflammatory bowel disease

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

Systematic review with meta-analysis: association between Helicobacter pylori CagA seropositivity and odds of inflammatory bowel disease

Adam Tepler et al. Aliment Pharmacol Ther. 2019 Jul.

Abstract

Background: Accumulating data support a protective role of Helicobacter pylori against inflammatory bowel diseases (IBD), which might be mediated by strain-specific constituents, specifically cagA expression.

Aim: To perform a systematic review and meta-analysis to more clearly define the association between CagA seropositivity and IBD.

Methods: We identified comparative studies that included sufficient detail to determine the odds or risk of IBD, Crohn's disease (CD) or ulcerative colitis (UC) amongst individuals with vs without evidence of cagA expression (eg CagA seropositivity). Estimates were pooled using a random effects model.

Results: Three clinical studies met inclusion criteria. cagA expression was represented by CagA seropositivity in all studies. Compared to CagA seronegativity overall, CagA seropositivity was associated with lower odds of IBD (OR 0.31, 95% CI 0.21-0.44) and CD (OR 0.25, 95% CI 0.17-0.38), and statistically nonsignificant lower odds for UC (OR 0.68, 95% CI 0.35-1.32). Similarly, compared to H pylori non-exposed individuals, H pylori exposed, CagA seropositive individuals had lower odds of IBD (OR 0.26, 95% CI 0.16-0.41) and CD (OR 0.23, 95% CI 0.15-0.35), but not UC (OR 0.66, 0.34-1.27). However, there was no significant difference in the odds of IBD, CD or UC between H pylori exposed, CagA seronegative and H pylori non-exposed individuals.

Conclusion: We found evidence for a significant association between CagA seropositive H pylori exposure and reduced odds of IBD, particularly CD, but not for CagA seronegative H pylori exposure. Additional studies are needed to confirm these findings and define underlying mechanisms.

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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
A, Odds of IBD associated with CagA seropositive vs CagA seronegative status (reference group: Helicobacter pylori exposed, CagA seronegative and H pylori non-exposed individuals). B, Odds of CD associated with CagA seropositive vs CagA seronegative status (reference group: H pylori exposed, CagA seronegative and H pylori non-exposed individuals). C, Odds of UC associated with CagA seropositive vs CagA seronegative status (reference group: H pylori exposed, CagA seronegative and H pylori non-exposed individuals)
FIGURE 3
FIGURE 3
A, Odds of IBD associated with Helicobacter pylori exposed, CagA seropositive vs H pylori non-exposed status. B, Odds of CD associated with H pylori exposed, CagA seropositive vs H pylori non-exposed status. C, Odds of UC associated with H pylori exposed, CagA seropositive vs H pylori non-exposed status
FIGURE 4
FIGURE 4
A, Odds of IBD associated with Helicobacter pylori exposed, CagA seronegative vs H pylori non-exposed status. B, Odds of CD associated with H pylori exposed, CagA seronegative vs H pylori non-exposed status. C, Odds of UC associated with H pylori exposed, CagA seronegative vs H pylori non-exposed status
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