Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis

Abstract

BACKGROUNDIrritable bowel syndrome (IBS) is a prevalent and debilitating gastrointestinal condition. Research has reported persistent, low-grade mucosal inflammation and significant overlaps between patients with IBS and those with dyspepsia, suggesting a possible pathogenic role of Helicobacter pylori (H. pylori) in IBS. This study therefore aimed to provide the first systematic review and meta-analysis on the association between H. pylori infection and IBS.AIMTo investigate the association between H. pylori infection and IBS.METHODSUsing the keywords “H. pylori OR Helicobacter OR Helicobacter pylori OR infection” AND “irritable bowel syndrome OR IBS”, a preliminary search of PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, Web of Science, Google Scholar and WanFang databases yielded 2924 papers published in English between 1 January 1960 and 1 June 2018. Attempts were also made to search grey literature.RESULTSA total of 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis. Random-effects meta-analysis found a slight increased likelihood of H. pylori infection in patients with IBS, albeit this was not statistically significant (pooled odds ratio 1.47, 95% confidence interval: 0.90-2.40, P = 0.123). It must also be acknowledged that all of the available studies reported only crude odd ratios. H. pylori eradication therapy also does not appear to improve IBS symptoms. Although publication bias was not observed in the funnel plot, there was a high degree of heterogeneity amongst the studies included in the meta-analysis (I2 = 87.38%).CONCLUSIONOverall, current evidence does not support an association between IBS and H. pylori infection. Further rigorous and detailed studies with larger sample sizes and after H. pylori eradication therapy are warranted.

Anti-Helicobacter pylori treatment can effectively improve the clinical remission rates of irritable bowel syndrome: a controlled clinical trial meta-analysis

“…A meta-analysis by L MR et al (41) suggested that H. pylori infection rates in IBS patients were significantly higher than expected in a healthy population. However, a similar meta-analysis by Ng et al (42) showed that there was no clear evidence to support an association between IBS and H. pylori; however this may be attributed to the smaller sample size in this study. Our results suggest that anti-H. pylori treatment could reduce IBS symptoms, and this may be mediated by the effects of anti-H. pylori treatments on gastrointestinal pH and flora changes, thereby promoting the recovery of the intestinal mucosal immune system and the gut-brain axis and restoring the regulation of the gastrointestinal hormone system (32).…”

The Association between Helicobacter pylori Infection and Irritable Bowel Syndrome: A Meta-Analysis

“…Similar to our findings, individuals with IBS had increased likelihood of H. pylori infection in a recent meta-analysis by Ng QX et al, though there was no statistical significance (OR: 1.47, 95% CI: 0.90-2.40) [33]. Compared to that meta-analysis, there were some differences of search methods and inclusion criteria in this study.…”

Association between Helicobacter pylori infection and irritable bowel syndrome

“…Our results (pooled OR 1.32, 95% CI: 0.94–1.87, P = .11) are very similar to those recently published by Ng et al [ 40 ] (pooled OR 1.47, 95%CI: 0.90–2.40, P = .123). Compared with their study, we conducted subgroup analysis, which showed a very positive correlation between IBS patients diagnosed in Rome III and H pylori infection and there was a negative correlation with H pylori infection in patients with IBS on the non-Roman III diagnostic criteria, the difference between the two groups was statistically significant ( P = .03).…”