Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 7073-7084
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7073
Helicobacter pylori infection and peptic ulcer disease in cirrhotic patients: An updated meta-analysis
Lin Wei, Hui-Guo Ding
Lin Wei, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated with Capital Medical University, Beijing 100069, China
Author contributions: Wei L contributed to collecting the data and writing the manuscript; Ding HG designed the project and was in charge of the manuscript; all the authors have read and approved the manuscript.
Supported by The State Key Projects Specialized on Infectious Diseases, No. 2017ZX10203202-004; and The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority, No. XXZ0801.
Conflict-of-interest statement: The authors deny any conflict of interest related to this 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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Hui-Guo Ding, MD, PhD, Chief Physician, Professor, Director, Department of Gastroenterology and Hepatology, Beijing You’an Hospital affiliated with Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China. dinghuiguo@ccmu.edu.cn
Received: March 23, 2021
Peer-review started: March 23, 2021
First decision: June 24, 2021
Revised: July 4, 2021
Accepted: July 13, 2021
Article in press: July 4, 2021
Published online: August 26, 2021
Processing time: 153 Days and 19.2 Hours
ARTICLE HIGHLIGHTS
Research background

Peptic ulcer (PU) is more prevalent in patients with liver cirrhosis than in the general population. What’s more, cirrhotic patients with PU have a significantly higher risk of PU bleeding than the general population. The role of Helicobacter pylori (H. pylori) infection in the pathogenesis of PU in patients with cirrhosis is still not elucidated.

Research motivation

Why cirrhotic patients have a higher risk of peptic ulcer? Whether this is related to H. pylori infection? If studies can prove that H. pylori is also an independent risk factor for PU in patients with liver cirrhosis, eradication of H. pylori can indirectly prevent PU bleeding in cirrhotic patients. With these doubts and questions, we performed this meta-analysis.

Research objectives

To perform a meta-analysis on the prevalence of H. pylori infection and PU and their association in liver cirrhosis patients.

Research methods

We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, Wangfang, and CQVIP databases from inception to July 10, 2020. Odds ratio (OR) and 95% confidence interval (CI) were pooled with a random-effects model. The statistical heterogeneity among studies (I2-index), subgroup analyses, regression analysis, sensitivity analysis, and the possibility of publication bias were assessed.

Research results

The prevalence of PU in patients with cirrhosis was 22%. The prevalence of H. pylori infection was 65.6% in cirrhotic patients with PU, and 52.5% in those without. The pooled overall OR was 1.73 (95%CI: 1.16-2.56, I2 = 66.2%, P < 0.001, Z = 2.7, Pz < 0.05). We did not find the cause of heterogeneity in the subgroup analyses and meta-regression analysis. We found that one study may be the source of the statistical heterogeneity through sensitivity analysis.

Research conclusions

There is a weakly positive association between H. pylori infection and PU in patients with liver cirrhosis.

Research perspectives

Prospective studies and reliable experimental designs should be further used to determine if H. pylori is an independent risk factor for PU in liver cirrhotic patients. If this link is confirmed in the near future, the eradication of H. pylori may become a new specific strategy to prevent non-variceal bleeding, especially PU hemorrhage in cirrhotic patients.