Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2019; 25(37): 5702-5710
Published online Oct 7, 2019. doi: 10.3748/wjg.v25.i37.5702
Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis
Qin Xiang Ng, Nadine Xinhui Foo, Wayren Loke, Yun Qing Koh, Vanessa Jing Min Seah, Alex Yu Sen Soh, Wee Song Yeo
Qin Xiang Ng, Nadine Xinhui Foo, Wayren Loke, Yun Qing Koh, Vanessa Jing Min Seah, Medicine, MOH Holdings Pte Ltd, Singapore 099253, Singapore
Qin Xiang Ng, General and Community Psychiatry, Institute of Mental Health, Singapore 117597, Singapore
Nadine Xinhui Foo, Yun Qing Koh, Vanessa Jing Min Seah, Department of General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
Alex Yu Sen Soh, Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore 119074, Singapore
Alex Yu Sen Soh, Wee Song Yeo, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Author contributions: Ng QX conceived the original idea; Soh AYS and Yeo WS supervised the study; Ng QX, Foo NX, Loke W and Koh YQ carried out the study, and the relevant data analysis and interpretation; Seah VJM, Soh AYS and Yeo WS contributed to the data analysis and interpretation; all authors discussed the results, contributed to the writing of the paper and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript. All the authors have no conflict of interest related to the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qin Xiang Ng, MBBS, Doctor, General and Community Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore 117597, Singapore. ng.qin.xiang@u.nus.edu
Telephone: +65-66386979
Received: May 29, 2019
Peer-review started: May 30, 2019
First decision: July 21, 2019
Revised: July 30, 2019
Accepted: September 9, 2019
Article in press: September 9, 2019
Published online: October 7, 2019
Processing time: 124 Days and 10.5 Hours
Abstract
BACKGROUND

Irritable bowel syndrome (IBS) is a prevalent and debilitating gastrointestinal condition. Research has reported persistent, low-grade mucosal inflammation and significant overlaps between patients with IBS and those with dyspepsia, suggesting a possible pathogenic role of Helicobacter pylori (H. pylori) in IBS. This study therefore aimed to provide the first systematic review and meta-analysis on the association between H. pylori infection and IBS.

AIM

To investigate the association between H. pylori infection and IBS.

METHODS

Using the keywords “H. pylori OR Helicobacter OR Helicobacter pylori OR infection” AND “irritable bowel syndrome OR IBS”, a preliminary search of PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, Web of Science, Google Scholar and WanFang databases yielded 2924 papers published in English between 1 January 1960 and 1 June 2018. Attempts were also made to search grey literature.

RESULTS

A total of 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis. Random-effects meta-analysis found a slight increased likelihood of H. pylori infection in patients with IBS, albeit this was not statistically significant (pooled odds ratio 1.47, 95% confidence interval: 0.90-2.40, P = 0.123). It must also be acknowledged that all of the available studies reported only crude odd ratios. H. pylori eradication therapy also does not appear to improve IBS symptoms. Although publication bias was not observed in the funnel plot, there was a high degree of heterogeneity amongst the studies included in the meta-analysis (I2 = 87.38%).

CONCLUSION

Overall, current evidence does not support an association between IBS and H. pylori infection. Further rigorous and detailed studies with larger sample sizes and after H. pylori eradication therapy are warranted.

Keywords: Irritable bowel syndrome; Functional; Helicobacter pylori; Infection; Meta-analysis

Core tip: This is the first systematic review to examine the association of Helicobacter pylori (H. pylori) infection and irritable bowel syndrome (IBS). 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis. Random-effects meta-analysis suggests a tenuous association between the two (pooled odds ratio 1.47, 95% confidence interval: 0.90-2.40, P = 0.123). H. pylori eradication therapy also does not appear to improve IBS symptoms in the limited studies available. Further detailed trials with larger sample sizes and after H. pylori eradication therapy are necessary to elucidate the relationship between H. pylori infection and IBS pathogenesis.