Edhi Ahmed, Gangwani Manesh K, Aziz Muhammad, Jaber Fouad, Khan Zubair, Inamdar Sumant, Thrift Aaron P, Desai Tusar K
Oakland University School of Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA -
Minerva Gastroenterol (Torino). 2024 Dec;70(4):454-462. doi: 10.23736/S2724-5985.24.03609-X. Epub 2024 May 10.
We conducted a meta-analysis evaluating the overall risk of esophageal adenocarcinoma (EAC) in individuals with Helicobacter pylori infection, and a network meta-analysis to assess the role of H. pylori infection in the progression from Barrett's esophagus (BE) to EAC.
The MEDLINE, EMBASE and Cochrane databases were searched between 1988 and June 2023 for observational studies of H. pylori infection and the risk of EAC. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using the DerSimonian-Laird method. I statistics were calculated to examine heterogeneity.
Thirteen studies were included in the meta-analysis and 3 additional studies were included in the network meta-analysis. For comparisons with controls, individuals with H. pylori infection were 46% less likely to develop EAC than individuals without H. pylori infection (OR, 0.54; 95% CI: 0.46, 0.64), with low heterogeneity between studies (I=4.4%). The magnitude of the inverse association was stronger in the two large cohort studies (OR=0.31) than in the 11 case-control studies (OR=0.55). When comparing to controls, the network meta-analysis of 6 studies showed that H. pylori infection was associated with a lower risk of GERD (OR=0.68) or BE (OR=0.59) or EAC (OR=0.54); however, H. pylori infection was not associated with risk of EAC in patients with BE (OR=0.91; 95% CI: 0.68, 1.21).
This meta-analysis provides the strongest evidence yet that H. pylori infection is inversely associated with EAC. H. pylori does not appear to be associated with BE progression to EAC.
我们进行了一项荟萃分析，以评估幽门螺杆菌感染个体患食管腺癌（EAC）的总体风险，并进行了一项网状荟萃分析，以评估幽门螺杆菌感染在巴雷特食管（BE）进展为EAC过程中的作用。
检索了1988年至2023年6月期间的MEDLINE、EMBASE和Cochrane数据库，以查找关于幽门螺杆菌感染与EAC风险的观察性研究。使用DerSimonian-Laird方法计算汇总比值比（OR）和95%置信区间（95%CI）。计算I统计量以检验异质性。
荟萃分析纳入了13项研究，网状荟萃分析纳入了另外3项研究。与对照组相比，幽门螺杆菌感染个体患EAC的可能性比未感染幽门螺杆菌的个体低46%（OR，0.54；95%CI：0.46，0.64），研究间异质性较低（I=4.4%）。两项大型队列研究中的反向关联强度（OR=0.31）强于11项病例对照研究（OR=0.55）。与对照组相比，6项研究的网状荟萃分析表明，幽门螺杆菌感染与GERD（OR=0.68）或BE（OR=0.59）或EAC（OR=0.54）风险较低相关；然而，幽门螺杆菌感染与BE患者的EAC风险无关（OR=0.91；95%CI：0.68，1.21）。
这项荟萃分析提供了迄今为止最有力的证据，表明幽门螺杆菌感染与EAC呈负相关。幽门螺杆菌似乎与BE进展为EAC无关。
