Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: A systematic review and meta‐analysis of observational studies

Abstract

Background The association between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD) has been shown in many observational studies, but these conclusions remain controversial. Hence, we performed a meta‐analysis to elucidate the association. Methods A comprehensive search was conducted on relevant studies published from inception to December 31, 2018, in PubMed, EMBASE, and Web of Science databases. Odds ratio (OR) with 95% confidence interval (95% CI) were pooled by random‐effect model, generic inverse variance method. Subgroup and sensitivity analyses were also done. Publication bias was estimated by the funnel plot, Begg's test, and Egger's test. Results Fifteen studies (eleven cross‐sectional, two case‐control, and two cohort studies) were included in this meta‐analysis. The pooled OR of NAFLD in patients with H. pylori infection was 1.19 (95% CI: 1.11‐1.29, P < 0.00001) when compared with the patients without H. pylori infection. Similar results were observed when the subgroup analyses were stratified by different geographical locations, study designs, and confounders adjustment. In subgroup analysis stratified by different H. pylori testing methods, the correlation still exists when using UBT, serology, RUT, or SAT, but there was no statistically significant difference when using multiple detection methods (OR = 2.96, 95% CI: 0.37‐23.94, P = 0.31). Sensitivity analyses showed that our results were robust. No evidence of substantial publication bias was detected. Conclusions Current evidence indicated that a positive association between H. pylori infection and the risk of NAFLD. Further prospective studies are warranted to strengthen the association and to clarify whether there is a causative link between them.

Active Helicobacter pylori Infection is Independently Associated with Nonalcoholic Steatohepatitis in Morbidly Obese Patients

“…Subsequently, other studies reported a positive association between Hp-I and NAFLD, including those of Yu et al [19], Sumida et al [38], Okushin et al [18], Kim et al [10,27], Zhang et al [21], Chen et al [26], Dogan et al [25], Abdel-Razik et al [24], and Kang et al [11]. Noteworthy, there have been five systematic reviews performed with meta-analysis, all of which revealed a positive association between the pathologies of interest [39][40][41][42][43]. Nonetheless, there are studies showing no association between Hp-I and NAFLD [14,15,19,20,22].…”

Nonalcoholic Fatty Liver Disease Is Associated with Helicobacter pylori Infection in North Urban Chinese: A Retrospective Study

“…Multiple studies have investigated the relationship between NAFLD and H. pylori infection, especially in Asia [18]. However, the conclusions were inconsistent and controversial.…”

“…The discrepancy among previous findings might result from the geographical location, study design, and confounder adjustment. Recently, a systematic review and meta-analysis of 15 observational studies (published between 2013 and 2018) involving 97228 participants showed a robust result that existed a positive association between H. pylori infection and the risk of NAFLD [18].…”

Associations between Helicobacter pylori with nonalcoholic fatty liver disease and other metabolic conditions in Guatemala

“…Recent evidence has suggested that H pylori is associated with the development of NAFLD 7‐11 . Several meta‐analyses, predominantly from studies of Asian populations, have reported H pylori infection‐NAFLD associations with pooled odds ratios ranging between 1.14 and 1.53 12‐16 …”