The Association Between Barretts Esophagus and Helicobacter pylori Infection: A Meta-Analysis

Fischbach LA et al. – Estimates for the effect of H. pylori on Barrett’s esophagus were heterogeneous across studies. The authors 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.

Methods

• The authors performed a comprehensive search to identify studies pertaining to the association between H. pylori and Barrett’s esophagus.
• They conducted meta-regression analyses to identify sources of variation in the effect of H. pylori on Barrett’s esophagus.

Results

• The 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]).

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