Journal
HELICOBACTER
Volume 17, Issue 3, Pages 163-175Publisher
WILEY
DOI: 10.1111/j.1523-5378.2011.00931.x
Keywords
Barrett's esophagus; Helicobacter pylori; meta-analysis
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Funding
- NIH [R01 116845]
- NIDDK [K24-04-107]
- Houston VA HSR&D Center of Excellence [HFP90-020]
- NIH/National Institute of Diabetes and Digestive and Kidney Disease [P30 DK56338]
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Objective: The effect of Helicobacter pylori on Barretts esophagus is poorly understood. We conducted a meta-analysis to summarize the existing literature examining the effect that H. pylori has on Barretts 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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