Helicobacter pylori infection contributes to high risk of ischemic stroke: evidence from a meta-analysis

Abstract

Chronic infection of Helicobacter pylori (H. pylori) in ischemic stroke (IS) incidence has been previously studied in several publications; however, conflicting results have been reported. A meta-analysis was used to assess whether chronic infection of H. pylori was associated with risk of IS, and which of the following was more effective for predication of IS risk, antibody IgG of H. pylori (anti-H. pylori IgG), antibody IgG of cytotoxin-associated gene-A (anti-Cag A IgG) or the (13)C-urea breath test. We searched the databases of Medline and Embase, and latest update was January 1, 2012. Case-control studies were considered to be eligible. The odds ratio (OR) and 95 % confidence interval (95 % CI) were calculated using the random-effect model. A total of 13 studies including 4,041 participants were included in this meta-analysis. Of these studies, ten, four and four studies were for anti-H. pylori IgG, anti-Cag A IgG and the (13)C-urea breath test, respectively. Combined analysis indicated that positive anti-H. pylori IgG, anti-Cag A IgG and (13)C-urea breath test were significantly associated with increased risk of IS, respectively, and positive anti-Cag A IgG was more effective for predication of IS risk [OR (95 % CI) = 1.60 (1.21-2.11), P (heterogeneity) = 0.001 for positive versus negative anti-H. pylori IgG; 2.33 (1.76-3.09), P (heterogeneity) = 0.71 for positive versus negative anti-Cag A IgG and 1.65 (1.11-2.47), P (heterogeneity) = 0.17 for positive versus negative (13)C-urea breath test]. In addition, we found that positive anti-H. pylori IgG was closely associated with risk of IS caused by atherosclerosis and small artery disease, but not for cardioembolic IS. This meta-analysis indicated that chronic H. pylori infection was significantly associated with an increased risk of IS, especially for non-cardioembolic IS. Compared with anti-H. pylori IgG and the (13)C-urea breath test, anti-Cag A IgG seemed more effective for prediction of risk of IS.

A meta-analysis of stroke risk following herpes zoster infection

“…A number of studies have suggested microbes play some role in inflammation, thereby accelerating atherosclerosis [29]. For example, Wang et al conducted a meta-analysis that showed Helicobacter pylori infection contributes to risk of ischemic stroke,[30] however a more recent analysis refuted this [31]. In their meta-analysis, Chen et al found an increased risk of cerebrovascular disease with the presence of IgG for Chlamydia pneumonia [32].…”

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015

“…The problem whether this Recent data showed an association between CagA-positive HP strains and ischemic heart disease (33,34). In addition, it has been suggested that HP might be playing a pathogenic role in rosacea (35).…”

Helicobacter pylori infection and prevalence of stroke

“…13,14,20,21 Sample sizes were small in some of these studies 21,25 and some did not control for potential confounders. For example, Heuschmann et al 13 26 and one that included 10 prospective studies reported null results: pooled OR 0.96 (95% CI: 0.78-1.14). Moreover, findings of these studies were conflicting.…”

“…For example, Heuschmann et al 13 and Coles et al 22 showed no significant association between H pylori seropositivity and ischemic stroke, while Sawayama et al 14 and Masoud et al 21 showed significant positive associations. Results of two meta-analyses were also conflicting; a meta-analysis of 13 case-control studies (4041 participants) showed a positive association: pooled odds ratio (OR) 1.60 (95% confidence intervals [CI]: 1.21-2.11) 26 and one that included 10 prospective studies reported null results: pooled OR 0.96 (95% CI: 0.78-1.14). 27 These two meta-analyses combined results from studies that used different classification methods for both H pylori infection and stroke.…”