Meta-analysis: the relationship between Helicobacter pylori infection and gastro-oesophageal reflux disease.
BACKGROUND
The relationship between Helicobacter pylori infection and its treatment and gastro-oesophageal reflux disease (GERD) is controversial.


OBJECTIVE
To establish if H. pylori infection is associated with the presence of GERD and if anti-H. pylori treatment leads to de novo GERD or rebound/exacerbation of GERD.


METHODS
A search of MEDLINE and EMBASE databases was made. Pooled odds ratios (OR) were calculated for de novo GERD and rebound/exacerbated GERD after anti-H. pylori therapy in case-control studies and in therapeutic trials.


RESULTS
Fourteen case-control studies and 10 clinical trials were included. Among case-control studies, pooled OR for the association between H. pylori negative status and GERD was 1.34 [95% confidence interval (CI) 1.15-1.55]. Among therapeutic trials, pooled OR for the association anti-H. pylori therapy - GERD was 2.54 (95% CI 1.92-3.37). The OR for de novo GERD was 3.25 (95% CI 2.09-5.33), and for rebound/exacerbated GERD was 2.39 (95% CI 1.75-3.34). Associations were higher among Asian studies than among North American and European studies.


CONCLUSIONS
This meta-analysis shows significant association between absence of H. pylori infection and GERD symptoms, and a positive association between anti-H. pylori therapy and occurrence of both de novo and rebound/exacerbated GERD. The significance of these associations appears to have been inflated by the effect of single trials and by geographical variations.
Cremonini
F
F
Clinical Enteric Neuroscience Translational & Epidemiological Research Program, Mayo Clinic and Mayo Foundation, Rochester, MN, USA. Cremonini.Filippo@mayo.edu
Di Caro
S
S
Delgado-Aros
S
S
Sepulveda
A
A
Gasbarrini
G
G
Gasbarrini
A
A
Camilleri
M
M
D016022:Case-Control Studies; D002986:Clinical Trials as Topic; D005764:Gastroesophageal Reflux / Q000382:microbiology*; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D012044:Regression Analysis