Systematic review with meta‐analysis: association of Helicobacter pylori infection with gastro‐oesophageal reflux and its complications

Abstract

Summary Background Conflicting results exist on the association between Helicobacter pylori infection and gastro‐oesophageal reflux (GOR), and its complications, such as erosive oesophagitis (EO) and Barrett's oesophagus (BO). Aims To explore the association of H. pylori infection with GOR symptoms and their complications Methods We searched Embase, PubMed, Web of Science and Scopus databases through December 2020 for relevant articles. Regarding the association between H. pylori and GOR symptoms (heartburn, regurgitation or reflux), we included observational studies comparing the prevalence of GOR symptoms between H. pylori‐positive and ‐negative individuals. Concerning the association between H. pylori and complications of GOR, we included studies comparing the prevalence of EO or BO between H. pylori‐positive and ‐negative individuals. Results In total, 36 papers were eligible. Based on seven cross‐sectional surveys, H. pylori infection was associated with a lower odds of GOR symptoms (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.61‐0.90). However, in four case‐control studies, H. pylori infection was not associated with odds of GOR symptoms (OR 1.10, 95% CI 0.85‐0.1.43). In 26 cross‐sectional studies in patients with GOR symptoms, the OR for EO was 0.70 (95% CI 0.58‐0.84) in H. pylori‐positive vs ‐negative cases. Based on nine cross‐sectional studies in subjects with GOR complications, no significant association was found between H. pylori infection and either endoscopically‐diagnosed (OR 1.84, 95% CI 0.67‐5.02) or histologically confirmed (OR 0.85, 95% CI 0.60‐1.20) BO. Conclusions Helicobacter pylori infection appears to be associated with a decreased odds of GOR symptoms and EO. In contrast, H. pylori infection did not seem to affect the odds of BO in patients with GER complications.

ECCO Guidelines on Inflammatory Bowel Disease and Malignancies

“…Duration of follow up was limited to 2 years. These findings are consistent with earlier metaanalyses, [241,242] which also showed no associations to overall risk of malignancy and were also limited by a relatively short follow-up duration.…”

Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

“…A most recent meta-analysis in line with previous meta-analyses reported a weak association of H. pylori infection with decreased gastro-oesophageal reflux symptoms and a weak negative association with mild oesophagitis; a negative association of H. pylori with Barrett’s oesophagus was not confirmed 386. Furthermore, in a nationwide population-based study in Sweden H. pylori eradication did not increase the risk for the development of oesophageal adenocarcinoma 387…”

Helicobacter pylori infection

“…In children, particularly in the USA and Europe, an inverse association between H. pylori infection and asthma and allergy has been reported [75][76][77] , although this link has not been unequivocally confirmed 78 . The often reported inverse association between H. pylori infection and the risk of gastro-oesophageal reflux disease (GERD), Barrett oesophagus and oesophageal adenocarcinoma remains highly controversial 79,80 , and evidence for positive and negative associations exists [79][80][81][82][83][84][85] . Explanations for the discrepancies might lie in differing study protocols and H. pylori testing methodologies as well as in heterogeneity in the selection of patient and control populations.…”