Helicobacterpylori Infection-A Risk Factor for Irritable Bowel Syndrome? An Updated Systematic Review and Meta-Analysis

Abstract

Nowadays, the relationship between Helicobacter pylori infection (HPI) and irritable bowel syndrome (IBS) remains controversial.

Objective: The aim of this study is to investigate the relationship between HPI and IBS through a systematic review and meta-analysis based on the current evidence.

Methods: We performed a systematic literature search in electronic databases (PubMed, EMBASE, and the Cochrane library) by computer to identify all reports published before 8 August 2021. The odds ratio (OR) and confidence interval (CI) were calculated to evaluate the association between HPI and IBS. Subgroup analyses were conducted for further assessment and exploration of heterogeneity sources. In addition, we assessed publication bias through funnel plots, Egger's test, and Begg's test. Finally, we conducted a sensitivity analysis to evaluate the robustness of the results.

Results: Thirteen studies with 13,173 participants were included in the meta-analysis. The pooled OR of the association between HPI and IBS was 1.03 (95% CI [0.80,1.31]; p = 0.84). The adjusted OR of the association between HPI and IBS after excluding the studies with confounding factors defined by our team was 1.29 (95% CI [1.03,1.62]; p = 0.03). We found a positive association between HPI and IBS-D (diarrhea subtype) (OR: 1.54; 95% CI [1.22,1.95]; p = 0.0003). The OR of the relationship between cytotoxin-associated gene A (Cag A) positive HPI and IBS was 4.3 (95% CI [0.51,36.17]; p = 0.18).

Conclusions: The likelihood of HPI in IBS patients is relatively higher than that of non-IBS participants but not statistically significant, implying that HPI is not significantly associated with IBS, albeit we may underestimate this association. Moreover, we found a positive association between HPI and IBS-D. We also observed an increased likelihood of Cag-A positive HPI in IBS patients than that of non-IBS participants but not statistically significant.

Keywords: Helicobacter pylori; functional gastrointestinal disorders; irritable bowel syndrome; meta-analysis.

Figure 1

The detailed search strategy used in PubMed.

Figure 2

PRISMA flow of study selection. Previous version of review, the previously published meta-analysis or systematic reviews regarding the similar topic. New studies, the studies not included in previously published meta-analysis or systematic reviews regarding the similar topic.

Figure 3

Forest plot of the overall association between HPI and IBS. M-H, Mantel–Haenszel; HPI, Helicobacter pylori infection; IBS, irritable bowel syndrome [14,16,27,28,29,30,31,32,33,34,35,36,37].

Figure 4

Forest plot of the adjusted association between HPI and IBS after the studies with defined confounding factors were excluded. M-H, Mantel–Haenszel; HPI, Helicobacter pylori infection; IBS, irritable bowel syndrome [16,27,28,32,33,35].

Figure 5

Forest plots of the associations between HPI and different subtypes of IBS. Forest plot of the association between HPI and IBS-D (a). Forest plot of the association between HPI and IBS-C (b). Forest plot of the association between HPI and IBS-M (c). M-H, Mantel–Haenszel; HPI, Helicobacter pylori infection; IBS-D, irritable bowel syndrome of diarrhea type; IBS-C, irritable bowel syndrome of constipation type; IBS-M, irritable bowel syndrome of mixed type [14,16,28,34].

Figure 6

Forest plot of the association between Cag A-positive HPI and IBS. M-H, Mantel–Haenszel; HPI, Helicobacter pylori infection; IBS, irritable bowel syndrome; Cag A, cytotoxin-associated gene A [14,32].

Figure 7

Funnel plot of publication bias assessment (a) and figure of sensitivity analysis (b) regarding overall association between HPI and IBS [14,16,27,28,29,30,31,32,33,34,35,36,37].