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
Abstract
BACKGROUND

Peptic ulcer (PU) is more prevalent in patients with liver cirrhosis. The role of Helicobacter pylori (H. pylori) infection in the pathogenesis of PU in patients with cirrhosis is still not elucidated.

AIM

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

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 using 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.

RESULTS

A total of 14 studies (13 cross-sectional studies; 1 cohort study) involving 2775 individuals (611 cases with PU and 2164 controls) were included in our meta-analysis. 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 except for one study. Funnel plot did not show significant publication bias. The results of Begg’s test and Egger’s test indicated no evidence of substantial publication bias (PBegg = 0.732, PEgger = 0.557).

CONCLUSION

There is a weakly positive association between H. pylori infection and PU in patients with liver cirrhosis. It is suggested that H. pylori infection may play a role in the pathogenesis of PU in liver cirrhotic patients.

Keywords: Helicobacter pylori; Peptic ulcer; Cirrhosis; Meta-analysis; Infection

Core Tip: 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 high risk of PU bleeding than the general population. So, if studies can prove that Helicobacter pylori (H. pylori) is also an independent risk factor for PU in patients with liver cirrhosis, the eradication of H. pylori can indirectly prevent PU bleeding in cirrhotic patients. This study showed that there is a weak positive association between H. pylori infection and PU in patients with liver cirrhosis.