Is there an association between Helicobacter pylori infection and irritable bowel syndrome? A meta-analysis

Table 1 Characteristics of all studies included in this meta-analysis (arranged alphabetically by first author’s last name)

First author, Year	Study design	Study sample (n)	Country	Diagnosis of IBS	Method of H. pylori detection	Odds ratio (95%CI)	Conclusions
Abdelrazak et al[10], 2015	Case control	550	Egypt	Rome III criteria	Stool antigen test or 13C-urea breath test positive	8.56 (4.06, 18.05)	Significantly higher rate of H. pylori detection in pediatric patients with IBS compared to healthy controls
Agreus et al[13], 1995	Case control	150	Sweden	More than 2 of the following symptoms (feeling of incomplete defecation, mucous stools, abdominal distension, abdominal pain or discomfort on defecation or relieved by defecation) and diarrhoea/constipation/or alternating diarrhoea and constipation and abdominal discomfort	Serum IgG by ELISA	0.56 (0.25, 1.25)	No association between H. pylori seropositivity and dyspepsia or IBS
Corsetti et al[14], 2004	Case control	309	Belgium	Rome II criteria	Gastric biopsy specimens	0.74 (0.36, 1.51)	The prevalence of H. pylori infection did not differ between patients with functional dyspepsia alone and patients with functional dyspepsia and IBS
El-Badry et al[15], 2018	Cross sectional	115	Egypt	Rome III criteria	H. pylori stool coproantigen	NA	H. pylori was detected in 55.7% of patients with IBS
Gerards et al[16], 2001	Case control	46	Germany	Not specified	13C-urea breath test	0.96 (0.24, 3.87)	Rectal distension produced abdominal pain only in patients with IBS and who were H. pylori infected. H. pylori may contribute to visceral hypersensitivity
Hasan et al[17], 2017	Cross sectional	184	Iraq	Based on clinical and ultrasonography results	Serum IgG by ELISA	0.54 (0.278, 1.03)	Rate of H. pylori infection similar between patients with IBS and healthy controls
Locke et al[18], 2000	Cross sectional	148	United States	Abdominal pain with at least two of six Manning criteria symptoms	Serum IgG by ELISA and CagA IgG	7.22 (2.91, 17.9)	After adjusting for age, CagA-positivity but not H. pylori seropositivity was associated with IBS
Malinen et al[12], 2005	Case control	49	Finland	Rome II criteria	Real-time PCR analysis of fecal samples	NA	H. pylori was not detected in any of the control or test subjects. PCR assay may lack sensitivity
McDonald et al[19], 2017	Cross sectional	112	Peru	Rome III criteria	Endoscopy specimens	NA	H. pylori infection was detected in 58 (57.4%) of patients with IBS
Su et al[20], 2000	Cross sectional	69	Taiwan	Rome I criteria	13C-urea breath test and endoscopy specimens	NA	H. pylori infection was detected in 33 (47.8%) of patients with IBS
Xiong et al[21], 2016	Case control	502	China	Rome III criteria	Not specified (presumably seropositivity)	0.96 (0.77, 1.19)	The prevalence of H. pylori infection in patients with IBS-D was similar to the general population and eradication therapy did not improve symptoms
Yakoob et al[22], 2012	Case control	330	Pakistan	Rome III criteria	Gastric biopsy specimens	1.76 (1.12, 2.75)	H. pylori infection was common in patients with IBS-D, and was associated with predominantly cagAs1-positive strains
Yang et al[11], 2017	Case control	670	China	Rome III criteria	Positive for rapid urease test and 14C-urea breath test	1.62 (1.19, 2.20)	The rate of H. pylori infection was significantly higher in patients with IBS-D than healthy controls, however, eradication of H. pylori did not improve symptoms

H. pylori: Helicobacter pylori; CagA: Cytotoxin-associated gene A; ELISA: Enzyme-linked immunosorbent assay; IBS: Irritable bowel syndrome; IBS-D: Irritable bowel syndrome associated with diarrhea; NA: Not available.