Meta-Analysis
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World J Gastroenterol. May 21, 2014; 20(19): 5903-5911
Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5903
Histological changes of gastric mucosa after Helicobacter pylori eradication: A systematic review and meta-analysis
Yan-Jun Kong, Hong-Gang Yi, Jun-Cheng Dai, Mu-Xin Wei
Yan-Jun Kong, Division of Traditional Chinese Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Hong-Gang Yi, Jun-Cheng Dai, Division of Epidemiology, Nanjing Medical University School of Public Health, Nanjing 210029, Jiangsu Province, China
Mu-Xin Wei, Division of Traditional Chinese Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Mu-Xin Wei, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan
Mu-Xin Wei, HiPep Laboratories, Kyoto 602-8158, Japan
Author contributions: Kong YJ collected the data and performed the meta-analysis; Dai JC and Yi HG participated in the retrieval of articles suitable for analysis; Wei MX provided guidance and proofread the manuscript.
Correspondence to: Mu-Xin Wei, Professor, Division of Traditional Chinese Medicine, the First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, Jiangsu Province, China. weimuxin@njmu.edu.cn
Telephone: +86-25-68136267 Fax: +86-25-83724440
Received: September 3, 2013
Revised: December 13, 2013
Accepted: January 8, 2014
Published online: May 21, 2014
Abstract

AIM: To systematically review pathological changes of gastric mucosa in gastric atrophy (GA) and intestinal metaplasia (IM) after Helicobacter pylori (H. pylori) eradication.

METHODS: A systematic search was made of PubMed, Web of Science, EMBASE, ClinicalTrials.gov, OVID and the Cochran Library databases for articles published before March 2013 pertaining to H. pylori and gastric premalignant lesions. Relevant outcomes from articles included in the meta-analysis were combined using Review Manager 5.2 software. A Begg’s test was applied to test for publication bias using STATA 11 software. χ2 and I2 analyses were used to assess heterogeneity. Analysis of data with no heterogeneity (P > 0.1, I2 < 25%) was carried out with a fixed effects model, otherwise the causes of heterogeneity were first analyzed and then a random effects model was applied.

RESULTS: The results of the meta-analysis showed that the pooled weighted mean difference (WMD) with 95%CI was 0.23 (0.18-0.29) between eradication and non-eradication of H. pylori infection in antral IM with a significant overall effect (Z = 8.19; P <0.00001) and no significant heterogeneity (χ2 = 27.54, I2 = 16%). The pooled WMD with 95%CI was -0.01 (-0.04-0.02) for IM in the corpus with no overall effect (Z = 0.66) or heterogeneity (χ2 = 14.87, I2 =0%) (fixed effects model). In antral GA, the pooled WMD with 95% CI was 0.25 (0.15-0.35) with a significant overall effect (Z = 4.78; P < 0.00001) and significant heterogeneity (χ2 = 86.12, I2 = 71%; P < 0.00001). The pooled WMD with 95% CI for GA of the corpus was 0.14 (0.04-0.24) with a significant overall effect (Z = 2.67; P = 0.008) and significant heterogeneity (χ2 = 44.79, I2 = 62%; P = 0.0003) (random effects model).

CONCLUSION: H. pylori eradication strongly correlates with improvement in IM in the antrum and GA in the corpus and antrum of the stomach.

Keywords: Helicobacter pylori eradication, Gastric atrophy, Intestinal metaplasia, Pathological changes, Gastric mucosa, Meta-analysis

Core tip: This study reports the results of a meta-analysis conducted on a large number of articles using an extensive and thorough method. The inclusion of only high-quality relevant articles resulted in the identification of a very strong correlation between the eradication of Helicobacter pylori infection and intestinal metaplasia of the antrum, and a strong correlation with gastric atrophy in both the antrum and the corpus of the stomach.