Tonsillar Helicobacter pylori Colonization in Chronic Tonsillitis Systematic Review and Meta-analysis

IMPORTANCE Helicobacter pylori colonization contributes significantly to multiple disease states, but its role in the development of tonsillar infection is unclear. Understanding the causes of chronic tonsillitis is important in clinical decision making of this commonly treated disease. OBJECTIVE To assess the correlation between H pylori colonization of tonsillar tissue in chronic tonsillitis and in noninfectious hyperplastic tonsils. DATA SOURCES We searched PubMed, MEDLINE, the Cochrane Trial Registry (through June 2014) and relevant article bibliographies. STUDY SELECTION Systematic review and meta-analysis of studies assessing the correlation between H pylori colonization in tonsillar tissues of patients undergoing tonsillectomy for either chronic tonsillitis or noninfectious causes. Included studies hypothesized that H pylori played a role in the development of chronic tonsillitis. All included studies investigated the presence of H pylori in tonsillar tissue removed for various indications. Included studies must have used an accepted method of testing for H pylori. DATA EXTRACTION AND ANALYSIS Studies were systematically reviewed by 2 independent reviewers for inclusion. Reported results of H pylori testing between tissues removed for infectious or noninfectious causes were systematically reviewed. The odds ratio of H pylori colonization in tissue removed for chronic tonsillitis compared with tissue removed for noninfectious causes was calculated using a random-effects model. RESULTS Six studies met inclusion criteria and had suitable data for pooling (n = 436). Of these, 2 studies measured H pylori colonization of tonsillar tissue in pediatric populations. One study analyzed tissue in both adult and pediatric populations. Noninfectious indications for tonsillectomy included sleep apnea or sleep-related breathing disorder, obstruction, carcinoma, and tonsillar hypertrophy. Overall, tonsillar H pylori colonization was found not to be significantly present more often in tissue samples removed secondary to recurrent infection rather than to noninfectious indications. The odds ratio of H pylori colonization in the tonsils of patients with chronic tonsillitis was 1.993 (95% CI, 0.909-4.371) (P = .09). CONCLUSIONS AND RELEVANCE Helicobacter pylori colonization was not found to be more prevalent on tonsillar tissue with chronic or recurrent infections. The reviewed studies provide no evidence that H pylori infection plays a role in the pathogenesis or development of chronic tonsillitis.