Association between Active Helicobacter pylori Infection and Glaucoma: A Systematic Review and Meta-Analysis

Abstract

Background: Glaucoma is the second most common cause of blindness worldwide affecting almost 70 million individuals. Helicobacter pylori (H. pylori) is a widespread pathogen with systematic pathogenicity. This meta-analysis aimed to estimate the contradictory data regarding a potential association between active H. pylori infection and glaucoma. Materials and Methods: A research in MEDLINE/PubMed and Google Scholar was conducted and original studies investigating the relationship between H. pylori infection and glaucoma were included. Analysis was performed with random effects model. The main outcome was the odds ratio (OR) with 95% confidence intervals (CI) of H. pylori infection as a risk factor for glaucoma. A parallel analysis studied the role of active infection as indicated by histology and the titer of anti-H. pylori antibodies. For the anti-H. pylori antibody titers, weighted mean differences (WMD) were estimated between patients and controls. Results: Fifteen studies were included, with 2664 participants (872 patients with glaucoma and 1792 controls), divided into primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudo-exfoliation glaucoma (PEG). The association between H. pylori infection and overall glaucoma was significant (OR = 2.08, CI 95% 1.48–2.93) with moderate heterogeneity (I2 = 61.54%). After stratification by glaucoma subtype, heterogeneity was eliminated in the NTG subgroup. Studies with healthy controls, and controls with anemia yielded very low or no heterogeneity, respectively. Gastric biopsy to document active H. pylori infection yielded the highest OR (5.4, CI: 3.17–9.2, p < 0.001) and null heterogeneity. For anti-H. pylori antibody titers, there was a significant difference in WMD between patients and controls (WMD 15.98 IU/mL; 95% CI: 4.09–27.87; p = 0.008); values were greater in glaucoma patients, with high heterogeneity (I2: 93.8%). Meta-regression analysis showed that mean age had a significant impact on glaucoma (p = 0.037). Conclusions: Active H. pylori infection may be associated with glaucoma with null heterogeneity, as, beyond histology, quantified by anti-H. pylori titers and increases with age.

Impact of Helicobacter pylori-Related Metabolic Syndrome Parameters on Arterial Hypertension

“…Beyond H. pylori-related gastric pathologies [37], H. pylori infection is also associated with MetS-related systemic pathologies, especially cardio-cerebrovascular, and neurodegenerative diseases, the endpoints of MetS [38][39][40][41][42][43]. It is important to note that almost all the aforementioned potential causative agents involved in the pathogenesis of arterial hypertension are also involved in the pathophysiology of H. pylori-related pathologies [36,[38][39][40][42][43][44][45][46][47][48][49][50][51][52][53][54][55].…”

Helicobacter pylori and Respiratory Diseases: 2021 Update

“…It is well known that H. pylori infection may lead to gastritis, peptic ulcer disease (PUD), gastric adenocarcinoma and gastric mucosaassociated lymphoid tissue (MALT) lymphoma [5], although most infected subjects remain asymptomatic. Furthermore, in the past few years, the possible role of H. pylori in many extra-gastric diseases has been investigated [6][7][8]. Among these, accumulating evidence also supports an association with neurodegeneration [9] and nonalcoholic fatty liver disease [6], although some controversy still exists.…”

Nonocular Influencing Factors for Primary Glaucoma: An Umbrella Review of Meta-Analysis

“…H. pylori infection had a significant association with glaucoma (OR [95% CI]: 2.08 [1.48–2.93]) [82]. H. pylori infection and the gastrointestinal microbiota dysbiosis could release inflammatory cytokines, resulting in inducible release of nitric oxide (NO) synthase and NO production and formation of reactive nitrogen species, such as peroxynitrite [83].…”