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Association Between Helicobacter pylori Exposure and Decreased Odds of Eosinophilic Esophagitis-A Systematic Review and Meta-analysis.

Authors
  • Shah, Shailja C1
  • Tepler, Adam2
  • Peek, Richard M Jr3
  • Colombel, Jean-Frederic4
  • Hirano, Ikuo5
  • Narula, Neeraj6
  • 1 Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: [email protected]
  • 2 Department of Medicine, Montefiore Medical Center, New York, New York.
  • 3 Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 4 Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
  • 5 Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
  • 6 Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. , (Canada)
Type
Published Article
Journal
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Publication Date
Oct 01, 2019
Volume
17
Issue
11
Identifiers
DOI: 10.1016/j.cgh.2019.01.013
PMID: 30659992
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Previous or current infection with Helicobacter pylori (exposure) has been reported to protect against eosinophilic esophagitis (EoE), perhaps owing to H pylori-induced immunomodulation. However, findings vary. We performed a systematic review and meta-analysis of comparative studies to define the association between H pylori exposure and EoE more clearly. We searched 4 large databases to identify comparative clinical studies that included sufficient detail to determine the odds or risk of EoE (primary outcome) or esophageal eosinophilia (secondary outcome) among individuals exposed to H pylori (exposed) vs individuals who were tested and found to be unexposed. Estimates were pooled using a random-effects model. Meta-regression and sensitivity analyses were planned a priori. Studies were evaluated for quality, risk of bias, publication bias, and heterogeneity. We analyzed 11 observational studies comprising data on 377,795 individuals worldwide. H pylori exposure vs nonexposure was associated with a 37% reduction in odds of EoE (odds ratio, 0.63; 95% CI, 0.51-0.78) and a 38% reduction in odds of esophageal eosinophilia (odds ratio, 0.62; 95% CI, 0.52-0.76). Fewer prospective studies found a significant association between H pylori exposure and EoE (P = .06) than retrospective studies. Effect estimates were not affected by study location, whether the studies were performed in pediatric or adult populations, time period (before vs after 2007), or prevalence of H pylori in the study population. In a comprehensive meta-analysis, we found evidence for a significant association between H pylori exposure and reduced odds of EoE. Studies are needed to determine the mechanisms of this association. Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

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