Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Medicine, Montefiore Medical Center, New York, New York.
Clin Gastroenterol Hepatol. 2019 Oct;17(11):2185-2198.e3. doi: 10.1016/j.cgh.2019.01.013. Epub 2019 Jan 16.
BACKGROUND & AIMS: Previous or current infection with Helicobacter pylori (exposure) has been reported to protect against eosinophilic esophagitis (EoE), perhaps owing to H pylori-induced immunomodulation. However, findings vary. We performed a systematic review and meta-analysis of comparative studies to define the association between H pylori exposure and EoE more clearly.
We searched 4 large databases to identify comparative clinical studies that included sufficient detail to determine the odds or risk of EoE (primary outcome) or esophageal eosinophilia (secondary outcome) among individuals exposed to H pylori (exposed) vs individuals who were tested and found to be unexposed. Estimates were pooled using a random-effects model. Meta-regression and sensitivity analyses were planned a priori. Studies were evaluated for quality, risk of bias, publication bias, and heterogeneity.
We analyzed 11 observational studies comprising data on 377,795 individuals worldwide. H pylori exposure vs nonexposure was associated with a 37% reduction in odds of EoE (odds ratio, 0.63; 95% CI, 0.51-0.78) and a 38% reduction in odds of esophageal eosinophilia (odds ratio, 0.62; 95% CI, 0.52-0.76). Fewer prospective studies found a significant association between H pylori exposure and EoE (P = .06) than retrospective studies. Effect estimates were not affected by study location, whether the studies were performed in pediatric or adult populations, time period (before vs after 2007), or prevalence of H pylori in the study population.
In a comprehensive meta-analysis, we found evidence for a significant association between H pylori exposure and reduced odds of EoE. Studies are needed to determine the mechanisms of this association.
先前或现症幽门螺杆菌（暴露）感染被报道可预防嗜酸性食管炎（EoE），这可能归因于 H pylori 诱导的免疫调节。然而，研究结果存在差异。我们进行了一项系统评价和荟萃分析，以更明确地定义 H pylori 暴露与 EoE 之间的关联。
我们检索了 4 个大型数据库，以确定包含足够详细信息的比较性临床研究，以确定暴露于 H pylori 的个体（暴露组）与经过检测且未暴露的个体（未暴露组）发生 EoE（主要结局）或食管嗜酸性粒细胞增多（次要结局）的比值比或风险。使用随机效应模型汇总估计值。计划了元回归和敏感性分析。对研究进行了质量评估、偏倚风险评估、发表偏倚评估和异质性评估。
我们分析了 11 项观察性研究，共纳入了来自全球的 377795 名个体的数据。与 H pylori 暴露相比，未暴露与 EoE 的比值比降低 37%（比值比，0.63；95%置信区间，0.51-0.78），与食管嗜酸性粒细胞增多的比值比降低 38%（比值比，0.62；95%置信区间，0.52-0.76）。与回顾性研究相比，前瞻性研究发现 H pylori 暴露与 EoE 之间存在显著关联的比例较低（P =.06）。研究地点、研究人群为儿科或成人、研究时间（2007 年之前与之后）以及研究人群中 H pylori 的流行率均不会影响效应估计值。
在一项全面的荟萃分析中，我们发现 H pylori 暴露与 EoE 发生几率降低之间存在显著关联的证据。需要进一步的研究来确定这种关联的机制。
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