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Ma S, Guo X, Wang C, Yin Y, Xu G, Chen H, Qi X. Association of Barrett's esophagus with Helicobacter pylori infection: a meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223221117971. [PMID: 36034104 PMCID: PMC9403448 DOI: 10.1177/20406223221117971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Barrett’s esophagus (BE) is the only recognized precursor for esophageal
adenocarcinoma. Helicobacter pylori (H.
pylori) infection is a major contributing factor towards upper
gastrointestinal diseases, but its relationship with BE remains
controversial. Some previous studies suggested that H.
pylori infection negatively correlated with BE, while others
did not. This may be attributed to the difference in the selection of
control groups among studies. The present meta-analysis aims to clarify
their association by combining all available data from well-designed
studies. Methods: The PubMed, EMBASE, and Cochrane
Library databases were searched. Odds ratios (ORs) with 95%
confidence intervals (CIs) were pooled by a random-effects model.
Heterogeneity was evaluated using the Cochran’s Q test and
I2 statistics. Meta-regression, subgroup,
and leave-one-out sensitivity analyses were employed to explore the sources
of heterogeneity. Results: Twenty-four studies with 1,354,369 participants were included. Meta-analysis
found that patients with BE had a significantly lower prevalence of
H. pylori infection than those without (OR = 0.53, 95%
CI = 0.45–0.64; p < 0.001). The heterogeneity was
statistically significant (I² = 79%;
p < 0.001). Meta-regression, subgroup, and leave-one-out
sensitivity analyses did not find any source of heterogeneity. Meta-analysis
of 7 studies demonstrated that CagA-positive H. pylori
infection inversely correlated with BE (OR = 0.25, 95% CI = 0.15–0.44;
p = 0.000), but not CagA-negative H.
pylori infection (OR = 1.22, 95% CI = 0.90–1.67;
p = 0.206). Meta-analysis of 4 studies also
demonstrated that H. pylori infection inversely correlated
with LSBE (OR = 0.39, 95% CI = 0.18–0.86; p = 0.019), but
not SSBE (OR = 0.73, 95% CI = 0.30–1.77; p = 0.484). Conclusion: H. pylori infection negatively correlates with BE. More
experimental studies should be necessary to elucidate the potential
mechanisms in future.
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Affiliation(s)
| | | | | | | | - Guangqin Xu
- Department of Gastroenterology, General
Hospital of Northern Theater Command, Shenyang, China
- Graduate School, Dalian Medical University,
Dalian, China
| | - Hongxin Chen
- Department of Gastroenterology, General
Hospital of Northern Theater Command, Shenyang, China
- Graduate School, Liaoning University of
Traditional Chinese Medicine, Shenyang, China
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Erőss B, Farkas N, Vincze Á, Tinusz B, Szapáry L, Garami A, Balaskó M, Sarlós P, Czopf L, Alizadeh H, Rakonczay Z, Habon T, Hegyi P. Helicobacter pylori infection reduces the risk of Barrett's esophagus: A meta-analysis and systematic review. Helicobacter 2018; 23:e12504. [PMID: 29938864 PMCID: PMC6055671 DOI: 10.1111/hel.12504] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The prevalence of Helicobacter pylori infection (HPI) has been decreasing in developed countries, with an increasing prevalence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) at the same time. The aim of our meta-analysis was to quantify the risk of BE in the context of HPI. METHODS A systematic search was conducted in 3 databases for studies on BE with data on prevalence of HPI from inception until December 2016. Odds ratios for BE in HPI were calculated by the random effects model with subgroup analyses for geographical location, presence of dysplasia in BE, and length of the BE segment. RESULTS Seventy-two studies were included in the meta-analysis, including 84 717 BE cases and 390 749 controls. The overall analysis showed that HPI reduces the risk of BE; OR = 0.68 (95% CI: 0.58-0.79, P < .001). Subgroup analyses revealed risk reduction in Asia OR = 0.53 (95% CI: 0.33-0.84, P = .007), Australia OR = 0.56 (95% CI: 0.39-0.80, P = .002), Europe OR = 0.77 (95% CI: 0.60-0.98, P = .035), and North-America OR = 0.59 (95% CI: 0.47-0.74, P < .001). The risk was significantly reduced for dysplastic BE, OR = 0.37 (95% CI: 0.26-0.51, P < .001) for non-dysplastic BE, OR = 0.51 (95% CI: 0.35-0.75, P = .001), and for long segment BE, OR = 0.25 (95% CI: 0.11-0.59, P = .001) in case of HPI. CONCLUSIONS This extensive meta-analysis provides additional evidence that HPI is associated with reduced risk of BE. Subgroup analyses confirmed that this risk reduction is independent of geographical location. HPI is associated with significantly lower risk of dysplastic, non-dysplastic, and long segment BE.
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Affiliation(s)
- Bálint Erőss
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Nelli Farkas
- Institute of BioanalysisMedical SchoolUniversity of PécsPécsHungary
| | - Áron Vincze
- Department of GastroenterologyFirst Department of MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Benedek Tinusz
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - László Szapáry
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - András Garami
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Márta Balaskó
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Patrícia Sarlós
- Department of GastroenterologyFirst Department of MedicineMedical SchoolUniversity of PécsPécsHungary
| | - László Czopf
- Department of CardiologyFirst Department of MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Hussain Alizadeh
- Department of HematologyFirst Department of MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Zoltán Rakonczay
- Department of PathophysiologyMedical SchoolUniversity of SzegedSzegedHungary
| | - Tamás Habon
- Department of CardiologyFirst Department of MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Péter Hegyi
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
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3
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[Usefulness of endoscopic biopsy in Barrett's esophagus]. Med Clin (Barc) 2012; 139:103-6. [PMID: 22206797 DOI: 10.1016/j.medcli.2011.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 05/12/2011] [Accepted: 05/17/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Endoscopy with random biopsies is the standard technique for the diagnosis of Barrett's esophagus (BE). We studied the usefulness of endoscopic biopsies in the diagnosis and surveillance of patients with BE. PATIENTS We reviewed all patients with BE controlled at the Hospital Clínic from February 2002 to March 2010. RESULTS During the study period, 493 endoscopies were performed in 206 patients. We excluded 86 patients who had undergone one endoscopy only, hence the final sample consisted of 117 patients (mean age 61 [12] years, 73% men) with 407 endoscopies and a mean follow-up of 45 (38) months. Fifty-seven patients had a short-BE (49%), 28 a long-BE (24%) and 32 (27%) could not be inferred from the report. In 25 cases (21%), intestinal metaplasia (IM) was not detected at the endoscopic index. During follow-up, biopsies were negative for IM at some point in 45 patients (38.4%) and there was a change in the histologic grade in 100 cases (24.6%). The presence of a short-BE (43% in short-BE vs 7% in long-BE, P=.001) and few biopsies (3 [1.5] vs 6.2 [4.5]; P=.005) were associated with a higher frequency of negative biopsies for IM. CONCLUSION Random endoscopic biopsies are not a good tool for diagnosis and surveillance of patients with BE.
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Fischbach LA, Nordenstedt H, Kramer JR, Gandhi S, Dick-Onuoha S, Lewis A, El-Serag HB. The association between Barrett's esophagus and Helicobacter pylori infection: a meta-analysis. Helicobacter 2012; 17:163-75. [PMID: 22515353 PMCID: PMC3335759 DOI: 10.1111/j.1523-5378.2011.00931.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The effect of Helicobacter pylori on Barrett's esophagus is poorly understood. We conducted a meta-analysis to summarize the existing literature examining the effect that H. pylori has on Barrett's esophagus. DESIGN We performed a comprehensive search to identify studies pertaining to the association between H. pylori and Barrett's esophagus. We conducted meta-regression analyses to identify sources of variation in the effect of H. pylori on Barrett's esophagus. RESULTS Our analysis included a total of 49 studies that examined the effect of H. pylori on Barrett's esophagus and seven studies that examined the effect of cag A positivity on Barrett's esophagus. Overall, H. pylori, and even more so cag A, tended to be protective for Barrett's esophagus in most studies; however, there was obvious heterogeneity across studies. The effect of H. pylori on Barrett's esophagus varied by geographic location and in the presence of selection and information biases. Only four studies were found without obvious selection and information bias, and these showed a protective effect of H. pylori on Barrett's esophagus (Relative risk = 0.46 [95% CI: 0.35, 0.60]). CONCLUSIONS Estimates for the effect of H. pylori on Barrett's esophagus were heterogeneous across studies. We identified selection and information bias as potential sources of this heterogeneity. Few studies without obvious selection and information bias have been conducted to examine the effect of H. pylori on Barrett's esophagus, but in these, H. pylori infection is associated with a reduced risk of Barrett's esophagus.
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Affiliation(s)
- Lori A. Fischbach
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX
| | - Helena Nordenstedt
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX,Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Jennifer R. Kramer
- Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Subi Gandhi
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX
| | - Sam Dick-Onuoha
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX
| | - Anthony Lewis
- Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX
| | - Hashem B. El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX,Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
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Helicobacter pylori infection and Barrett's esophagus: a systematic review and meta-analysis. Am J Gastroenterol 2009; 104:492-500; quiz 491, 501. [PMID: 19174811 DOI: 10.1038/ajg.2008.37] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The majority of distal esophageal adenocarcinomas are believed to arise in patients with Barrett's esophagus (BE). Helicobacter pylori (H. pylori) infection plays an etiological role in gastric carcinogenesis, but any possible role in BE is uncertain. We aimed to explore the possible relationship between H. pylori infection and BE by meta-analysis. METHODS Observational studies comparing the prevalence of H. pylori infection in patients with BE and healthy controls conducted in adult populations and published in all languages were identified through MEDLINE, EMBASE, and Cochrane database searches up to week 5, 2008. H. pylori infection had to be confirmed by histology and/or serology and/or RUT and/or culture. Studies were excluded if no raw data for outcomes of interest were available or controls were patients with disease or duplicate publications. Summary effect size was calculated as odds ratio (OR) and 95% confidence intervals (CIs) by the random-effects model using Review Manager 4.2.8. RESULTS Of 519 citations identified, a total of 12 case-control studies compared the prevalence of H. pylori infection in BE (n=550) and controls (9 studies included controls with normal endoscopy and 3 studies used healthy blood donors as control, n=2,979). There was no significant difference in the overall prevalence of H. pylori infection between BE and controls (42.9% vs. 43.9%, OR=0.74, 95% CI 0.40-1.37, P=0.34), but with significant heterogeneity. Subgroup analysis showed that the prevalence of H. pylori infection was significantly lower in BE than in endoscopically normal healthy controls (23.1% vs. 42.7%, OR=0.50, 95% CI 0.27-0.93, P=0.03) with significant heterogeneity observed between studies. The heterogeneity was eliminated by excluding a single Asian outlier study. In contrast, H. pylori infection was significantly increased in BE patients in the three studies using healthy blood donors as "normal controls" (71.2% vs. 48.1%, OR=2.21, 95% CI 1.07-4.55). In BE patients, the prevalence of H. pylori infection was significantly lower in the esophagus than in the stomach (3.3% vs. 24.7%, OR=0.14, 0.03-0.67) in three studies. CONCLUSIONS H. pylori infection and BE are inversely related when compared with endoscopically normal controls but not blood donor controls. Limited evidence suggests that there is no clear association between H. pylori infection and BE. To determine more accurately the effect size of H. pylori infection in BE, high quality prospective case-control studies with age-matched, endoscopically normal healthy controls are needed.
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Song ZZ. The influential factors of left atrial volume. Am J Gastroenterol 2008; 103:241; author reply 241. [PMID: 18184128 DOI: 10.1111/j.1572-0241.2007.01562_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Unal S, Karakan T, Dogan I, Cindoruk M, Dumlu S. The influence of Helicobacter pylori infection on the prevalence of endoscopic erosive esophagitis. Helicobacter 2006; 11:556-61. [PMID: 17083377 DOI: 10.1111/j.1523-5378.2006.00458.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to determine the frequency of endoscopic esophagitis and Helicobacter pylori infection in a large Turkish population over a 6-year period. METHODS We studied a consecutive series of 14,380 patients who had been newly referred for diagnostic esophagogastroduodenoscopy from 2000 to 2006. The mean age value was 45 +/- 10 (18-89) years. All endoscopic findings were retrospectively evaluated. Two antral and two corpus biopsies were taken from patients for rapid urease test. Endoscopic esophagitis was defined as the presence of erosions and/or ulceration. The relationship between erosive esophagitis and various relevant factors was analyzed. RESULTS The overall prevalence of endoscopic esophagitis was 7.8% (95% CI, 6.9-8.1). The prevalence of positive rapid urease test was 49% (95% CI, 38-53) in patients with esophagitis and 85% (95% CI, 70-96) in patients without esophagitis (p < .001). From 2000 to 2006, the frequency of endoscopic esophagitis and the rate of positive rapid urease test remained unchanged. After adjusting for the effects of mean age, male gender, and percentage of hiatal hernia, there was a 0.785% risk reduction in esophagitis with every 1% increase in the rate of positive rapid urease test result. CONCLUSIONS The frequency of endoscopic esophagitis is significantly lower in patients with a positive rapid urease test result. This negative correlation with H. pylori infection reflects a protective effect of H. pylori from endoscopic esophagitis in a Turkish population and deserves further investigation.
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Affiliation(s)
- Selahattin Unal
- Department of Gastroenterology, Gazi University, Ankara, Turkey
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Ferrández A, Benito R, Arenas J, García-González MA, Sopeña F, Alcedo J, Ortego J, Sainz R, Lanas A. CagA-positive Helicobacter pylori infection is not associated with decreased risk of Barrett's esophagus in a population with high H. pylori infection rate. BMC Gastroenterol 2006; 6:7. [PMID: 16483364 PMCID: PMC1388227 DOI: 10.1186/1471-230x-6-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 02/16/2006] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND & AIM The role that H. pylori infection plays in the development of and Barrett's esophagus (BE) is uncertain. We tested the hypothesis that infection with cagA+ Helicobacter pylori strains protects against the development of BE. METHODS We studied 104 consecutive patients, residents in an area with a high prevalence of H. pylori infection, with BE and 213 sex- and age-matched controls. H. pylori infection and CagA antibody status were determined by western blot serology. RESULTS H. pylori prevalence was higher in patients with BE than in controls (87.5% vs. 74.6%; OR. 2.3; 95% CI: 1.23-4.59). Increasing age was associated with a higher prevalence of H. pylori (p < 0.05). The prevalence of CagA+ H. pylori serology was similar in patients with BE and controls (64.4% vs. 54.5%; NS). Type I H. pylori infection (CagA+ and VacA+) was similar in patients with BE and controls (44.2% vs. 41.3%; NS). Logistic regression analysis identified alcohol (O.R. 7.09; 95% CI 2.23-22.51), and H. pylori infection (OR: 2.41; 95%CI: 1.20-4.84) but not CagA+ serology as independent factors. CONCLUSION Neither H. pylori infection nor H. pylori infection by CagA+ strains reduce the risk of BE in a population with high prevalence of H. pylori infection.
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Affiliation(s)
- Angel Ferrández
- Gastrointestinal Oncology Unit, Service of Digestive Diseases, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Rafael Benito
- Service of Microbiology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Juan Arenas
- Gastrointestinal Oncology Unit, Service of Digestive Diseases, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | | | - Federico Sopeña
- Gastrointestinal Oncology Unit, Service of Digestive Diseases, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Javier Alcedo
- Gastrointestinal Oncology Unit, Service of Digestive Diseases, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Javier Ortego
- Department of Pathology, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Ricardo Sainz
- Gastrointestinal Oncology Unit, Service of Digestive Diseases, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
| | - Angel Lanas
- Gastrointestinal Oncology Unit, Service of Digestive Diseases, Hospital Clínico "Lozano Blesa", Zaragoza, Spain
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Gisbert JP, Piqué JM. Indicaciones y consecuencias de la erradicación de Helicobacter pylori en la enfermedad por reflujo gastroesofágico. Med Clin (Barc) 2005; 124:697-709. [PMID: 15899166 DOI: 10.1157/13075094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Several epidemiological data indicate that H. pylori infection prevalence in patients with gastroesophageal reflux disease (GERD) is lower than that reported in respective controls, which would suggest that the organism plays a protective role against this disease. On the other hand, most studies demonstrate that the presence of the infection in patients with GERD does not negatively affect the therapeutic efficacy of proton pump inhibitors (PPIs), and, in case of negatively influencing it, the effects are not clinically relevant and are easily controllable with standard antisecretory treatment. Therefore, the decision to administer H. pylori eradication treatment to a patient should not be influenced by the concomitant presence of GERD. In most cases, H. pylori eradication does not seem to induce GERD development, and it does not seem to worsen GERD when it was already present. Nevertheless, when the gastritis pattern is unknown before the antibiotic administration, the effect of H. pylori eradication on gastric acid secretion and the incidence of GERD is unpredictable. In the exceptional cases in which H. pylori eradication could have negative effects on GERD, its clinical relevance will be limited, and reflux symptoms or endoscopic esophagitis will favourably respond to the standard PPI antisecretory treatment. Therefore, again, when H. pylori eradication is indicated in a particular patient, the concomitant diagnosis of GERD should not change our attitude. Finally, is has recently been recommended to eradicate H. pylori infection in those patients with GERD needing long-term treatment with PPI, as some studies have reported that these drugs induce, in presence of the organism, an atrophic gastritis, with the consequent risk of gastric cancer. However, most of these studies have important methodological defects, and several authors have reported contrary results. In any case, the appearance in the gastric mucosa of clinically relevant lesions, such as intestinal metaplasia, dysplasia or adenocarcinoma, in patients treated with PPI for several years, has not yet been demonstrated, although this could simply be a problem of time. This question seems to be too controversial to be answered with the available data, and we should wait until new studies clarify this topic. In the meantime, as it occurs with any controversial indication, the decision of the doctor facing a patient infected by H. pylori and needing maintenance therapy with PPIs should be assessed on a case by case basis.
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Affiliation(s)
- Javier P Gisbert
- Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, España.
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