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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis
Qin Xiang Ng, Nadine Xinhui Foo, Wayren Loke, Yun Qing Koh, Vanessa Jing Min Seah, Alex Yu Sen Soh, Wee Song Yeo
Qin Xiang Ng, Nadine Xinhui Foo, Wayren Loke, Yun Qing Koh, Vanessa Jing Min Seah, Medicine, MOH Holdings Pte Ltd, Singapore 099253, Singapore
Qin Xiang Ng, General and Community Psychiatry, Institute of Mental Health, Singapore 117597, Singapore
Nadine Xinhui Foo, Yun Qing Koh, Vanessa Jing Min Seah, Department of General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
Alex Yu Sen Soh, Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore 119074, Singapore
Alex Yu Sen Soh, Wee Song Yeo, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Author contributions: Ng QX conceived the original idea; Soh AYS and Yeo WS supervised the study; Ng QX, Foo NX, Loke W and Koh YQ carried out the study, and the relevant data analysis and interpretation; Seah VJM, Soh AYS and Yeo WS contributed to the data analysis and interpretation; all authors discussed the results, contributed to the writing of the paper and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript. All the authors have no conflict of interest related to the 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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Qin Xiang Ng, MBBS, Doctor, General and Community Psychiatry, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore 117597, Singapore. ng.qin.xiang@u.nus.edu
Telephone: +65-66386979
Received: May 29, 2019
Peer-review started: May 30, 2019
First decision: July 21, 2019
Revised: July 30, 2019
Accepted: September 9, 2019
Article in press: September 9, 2019
Published online: October 7, 2019
ARTICLE HIGHLIGHTS
Research background
Helicobacter pylori (H. pylori) is a prevalent gram-negative bacterium found in the human gut. H. pylori infection has been linked to several conditions, including dyspepsia and even hyperemesis gravidarum. However, its role in the pathogenesis of irritable bowel syndrome (IBS) remains largely unknown.
Research motivation
An improved understanding of the pathogenic mechanisms of IBS may lead to more effective therapeutics.
Research objectives
To investigate the association between H. pylori infection and IBS.
Research methods
A comprehensive search of PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, Web of Science, Google Scholar and WanFang databases was performed using the keywords “H. pylori OR Helicobacter OR Helicobacter pylori OR infection” AND “irritable bowel syndrome OR IBS”.
Research results
A total of 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis. Random-effects meta-analysis found a slight increased likelihood of H. pylori infection in patients with IBS, albeit this was not statistically significant (pooled odds ratio 1.47, 95% confidence interval: 0.90-2.40, P = 0.123). H. pylori eradication therapy also does not appear to improve IBS symptoms in the limited studies available.
Research conclusions
Current evidence does not support an association between IBS and H. pylori infection. This relationship is complicated by admittedly problematic study designs and potential confounding factors. H. pylori is eradicated with antibiotics, which is also associated with a significantly increased risk of developing IBS and may also aggravate IBS symptoms.
Research perspectives
Further rigorous and detailed trials with larger sample sizes, carefully selected subjects, and after H. pylori eradication therapy are warranted. The influence of H. pylori on gut microbiota also remains unknown and should be investigated.
