Helicobacter pylori infection reduces the risk of Barrett's esophagus: A meta-analysis and systematic review

IntroductionThe prevalence of Helicobacter pylori infection (HPI) has been decreasing in developed countries, with an increasing prevalence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) at the same time. The aim of our meta-analysis was to quantify the risk of BE in the context of HPI. MethodsA systematic search was conducted in 3 databases for studies on BE with data on prevalence of HPI from inception until December 2016. Odds ratios for BE in HPI were calculated by the random effects model with subgroup analyses for geographical location, presence of dysplasia in BE, and length of the BE segment. ResultsSeventy-two studies were included in the meta-analysis, including 84717 BE cases and 390749 controls. The overall analysis showed that HPI reduces the risk of BE; OR=0.68 (95% CI: 0.58-0.79, P<.001). Subgroup analyses revealed risk reduction in Asia OR=0.53 (95% CI: 0.33-0.84, P=.007), Australia OR=0.56 (95% CI: 0.39-0.80, P=.002), Europe OR=0.77 (95% CI: 0.60-0.98, P=.035), and North-America OR=0.59 (95% CI: 0.47-0.74, P<.001). The risk was significantly reduced for dysplastic BE, OR=0.37 (95% CI: 0.26-0.51, P<.001) for non-dysplastic BE, OR=0.51 (95% CI: 0.35-0.75, P=.001), and for long segment BE, OR=0.25 (95% CI: 0.11-0.59, P=.001) in case of HPI. ConclusionsThis extensive meta-analysis provides additional evidence that HPI is associated with reduced risk of BE. Subgroup analyses confirmed that this risk reduction is independent of geographical location. HPI is associated with significantly lower risk of dysplastic, non-dysplastic, and long segment BE.