title: Meta-analysis: eradication of Helicobacter pylori infection is associated with the development of endoscopic gastroesophageal reflux disease.
abstract: OBJECTIVE
  The role of Helicobacter pylori infection in the pathogenesis of gastroesophageal reflux disease (GORD) is controversial. We aimed to confirm the negative association between H. pylori infection and endoscopic GORD and further determine whether eradication of the infection is associated with the development of endoscopic GORD.
  
  
  METHODS
  Case-control studies comparing the prevalence of H. pylori infection between patients with and those without GORD, type A cohort studies comparing the incidence of GORD between patients with and those without anti-H. pylori eradication therapy, and type B cohort studies comparing the incidence of GORD between H. pylori-positive patients with and those without successful eradication were included. Moreover, the effects of H. pylori eradication on the development of GORD in randomized-controlled trials were also analyzed.
  
  
  RESULTS
  Overall, 43 studies were analyzed. Case-control studies showed a lower prevalence of H. pylori infection in patients with GORD [odds ratio 0.64, 95% confidence interval (CI) 0.49-0.83]. Type A cohort studies showed an increased incidence of GORD in patients whose H. pylori infection was successfully eradicated [risk ratio (RR) 2.50, 95% CI 1.46-4.26]. Type B cohort studies showed that patients whose H. pylori had been eradicated had a higher risk of GORD (RR 1.70, 95% CI 1.30-2.23). Moreover, randomized-controlled trials showed that H. pylori eradication leads to a higher risk of GORD (RR 1.99, 95% CI 1.23-3.22); subanalyses showed that the risk existed especially in Asian studies (RR 4.53, 95% CI 1.66-12.36).
  
  
  CONCLUSIONS
  H. pylori infection shows a negative association with the development of endoscopic GORD. Eradication of the infection may be a risk factor for de-novo endoscopic GORD, especially in Asian populations.
authors.affiliation: Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Xie
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Cui
authors.forename: Haoxuan
authors.initials: H
authors.lastname: Zheng
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.forename: Ling
authors.initials: L
authors.lastname: He
authors.forename: Bo
authors.initials: B
authors.lastname: Jiang
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004945:Esophagoscopy; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D017594:Publication Bias; D012107:Research Design; D018570:Risk Assessment / Q000379:methods; D013559:Symbiosis / Q000187:drug effects / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors