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Original research
Association between Helicobacter pylori infection and irritable bowel syndrome: a systematic review and meta-analysis
  1. Chunmei Wang1,2,
  2. Yue Yin1,2,
  3. Le Wang1,3,
  4. Xiaozhong Guo1,
  5. Lu Liu1,4,
  6. Xingshun Qi1
  1. 1Meta-Analysis Interest Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
  2. 2Graduate School, Jinzhou Medical University, Jinzhou, China
  3. 3Graduate School, China Medical University, Shenyang, China
  4. 4Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
  1. Correspondence to Dr Xingshun Qi, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, China; xingshunqi{at}126.com; Professor Xiaozhong Guo, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, China; guo_xiao_zhong{at}126.com; Dr Lu Liu, Section of Medical Service, General Hospital of Northern Theater Command, Shenyang 110840, China; chloe212{at}live.cn

Abstract

Background Helicobacter pylori infection and irritable bowel syndrome (IBS) negatively affect the quality of life. Some previous studies found that H. pylori infection should be positively associated with the risk of IBS, but others did not. The present study aims to clarify this association, and to further analyse whether H. pylori treatment can improve IBS symptoms.

Materials and methods The PubMed, EMBASE, Cochrane library, Chinese National Knowledge Infrastructure, China Science and Technology Journal and Wanfang databases were searched. Meta-analysis was performed using a random-effect model. The pooled odds ratios (ORs)/risk ratios (RRs) and their 95% CIs were calculated. Heterogeneity was evaluated using the Cochran’s Q test and I2 statistics. Meta-regression analysis was used to explore the sources of heterogeneity.

Results Thirty-one studies with 21 867 individuals were included. Meta-analysis of 27 studies found that patients with IBS had a significantly higher risk of H. pylori infection than those without (OR=1.68, 95% CI 1.29 to 2.18; p<0.001). The heterogeneity was statistically significant (I²=85%; p<0.001). Meta-regression analyses indicated that study design and diagnostic criteria of IBS might be the potential sources of heterogeneity. Meta-analysis of eight studies demonstrated that H. pylori eradication treatment had a higher improvement rate of IBS symptoms (RR=1.24, 95% CI 1.10 to 1.39; p<0.001). The heterogeneity was not significant (I²=32%; p=0.170). Meta-analysis of four studies also demonstrated that successful H. pylori eradication had a higher improvement rate of IBS symptoms (RR=1.25, 95% CI 1.01 to 1.53; p=0.040). The heterogeneity was not significant (I²=1%; p=0.390).

Conclusion H. pylori infection is associated with an increased risk of IBS. H. pylori eradication treatment can improve IBS symptoms.

Data availability statement

Data are available upon request. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

http://dx.doi.org/10.1136/postgradmedj-2021-141127

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    Data availability statement

    Data are available upon request. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • CW, YY and LW contributed equally.

    • Contributors Guarantor: XQ. Conceptualisation: XQ. Methodology: CW and XQ. Formal analysis: CW, YY, LW, XG, LL and XQ. Data curation: CW, YY, LW and XQ. Writing–original draft: CW and XQ. Writing–review and editing: CW, YY, LW, XG, LL and XQ. Supervision: XG, LL and XQ. All authors have made an intellectual contribution to the manuscript and approved the submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The authors declare that they have no competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.