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Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: A systematic review and meta-analysis of observational studies.
Helicobacter. 2019 Jun; 24(3):e12576.H

Abstract

BACKGROUND

The association between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD) has been shown in many observational studies, but these conclusions remain controversial. Hence, we performed a meta-analysis to elucidate the association.

METHODS

A comprehensive search was conducted on relevant studies published from inception to December 31, 2018, in PubMed, EMBASE, and Web of Science databases. Odds ratio (OR) with 95% confidence interval (95% CI) were pooled by random-effect model, generic inverse variance method. Subgroup and sensitivity analyses were also done. Publication bias was estimated by the funnel plot, Begg's test, and Egger's test.

RESULTS

Fifteen studies (eleven cross-sectional, two case-control, and two cohort studies) were included in this meta-analysis. The pooled OR of NAFLD in patients with H. pylori infection was 1.19 (95% CI: 1.11-1.29, P < 0.00001) when compared with the patients without H. pylori infection. Similar results were observed when the subgroup analyses were stratified by different geographical locations, study designs, and confounders adjustment. In subgroup analysis stratified by different H. pylori testing methods, the correlation still exists when using UBT, serology, RUT, or SAT, but there was no statistically significant difference when using multiple detection methods (OR = 2.96, 95% CI: 0.37-23.94, P = 0.31). Sensitivity analyses showed that our results were robust. No evidence of substantial publication bias was detected.

CONCLUSIONS

Current evidence indicated that a positive association between H. pylori infection and the risk of NAFLD. Further prospective studies are warranted to strengthen the association and to clarify whether there is a causative link between them.

Authors+Show Affiliations

Department of Gastroenterology, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, Hubei Province, China.Department of Science and Education, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, Hubei Province, China.Shanghai University of Traditional Chinese Medicine, Shanghai, China.Department of Clinical Immunology and Rheumatology, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, Hubei Province, China.Department of Hepatobiliary Surgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China.Department of Gastroenterology, The People's Hospital of China Three Gorges University and The First People's Hospital of Yichang, Yichang, Hubei Province, China.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30907050

Citation

Zhou, Ben-Gang, et al. "Association Between Helicobacter Pylori Infection and Nonalcoholic Fatty Liver Disease: a Systematic Review and Meta-analysis of Observational Studies." Helicobacter, vol. 24, no. 3, 2019, pp. e12576.
Zhou BG, Yang HJ, Xu W, et al. Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: A systematic review and meta-analysis of observational studies. Helicobacter. 2019;24(3):e12576.
Zhou, B. G., Yang, H. J., Xu, W., Wang, K., Guo, P., & Ai, Y. W. (2019). Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: A systematic review and meta-analysis of observational studies. Helicobacter, 24(3), e12576. https://doi.org/10.1111/hel.12576
Zhou BG, et al. Association Between Helicobacter Pylori Infection and Nonalcoholic Fatty Liver Disease: a Systematic Review and Meta-analysis of Observational Studies. Helicobacter. 2019;24(3):e12576. PubMed PMID: 30907050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Helicobacter pylori infection and nonalcoholic fatty liver disease: A systematic review and meta-analysis of observational studies. AU - Zhou,Ben-Gang, AU - Yang,Huai-Jie, AU - Xu,Wei, AU - Wang,Kai, AU - Guo,Peng, AU - Ai,Yao-Wei, Y1 - 2019/03/25/ PY - 2018/12/14/received PY - 2019/02/01/revised PY - 2019/02/07/accepted PY - 2019/3/25/pubmed PY - 2019/8/27/medline PY - 2019/3/26/entrez KW - Helicobacter pylori KW - meta-analysis KW - nonalcoholic fatty liver disease KW - observational studies SP - e12576 EP - e12576 JF - Helicobacter JO - Helicobacter VL - 24 IS - 3 N2 - BACKGROUND: The association between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD) has been shown in many observational studies, but these conclusions remain controversial. Hence, we performed a meta-analysis to elucidate the association. METHODS: A comprehensive search was conducted on relevant studies published from inception to December 31, 2018, in PubMed, EMBASE, and Web of Science databases. Odds ratio (OR) with 95% confidence interval (95% CI) were pooled by random-effect model, generic inverse variance method. Subgroup and sensitivity analyses were also done. Publication bias was estimated by the funnel plot, Begg's test, and Egger's test. RESULTS: Fifteen studies (eleven cross-sectional, two case-control, and two cohort studies) were included in this meta-analysis. The pooled OR of NAFLD in patients with H. pylori infection was 1.19 (95% CI: 1.11-1.29, P < 0.00001) when compared with the patients without H. pylori infection. Similar results were observed when the subgroup analyses were stratified by different geographical locations, study designs, and confounders adjustment. In subgroup analysis stratified by different H. pylori testing methods, the correlation still exists when using UBT, serology, RUT, or SAT, but there was no statistically significant difference when using multiple detection methods (OR = 2.96, 95% CI: 0.37-23.94, P = 0.31). Sensitivity analyses showed that our results were robust. No evidence of substantial publication bias was detected. CONCLUSIONS: Current evidence indicated that a positive association between H. pylori infection and the risk of NAFLD. Further prospective studies are warranted to strengthen the association and to clarify whether there is a causative link between them. SN - 1523-5378 UR - https://www.unboundmedicine.com/medline/citation/30907050/Association_between_Helicobacter_pylori_infection_and_nonalcoholic_fatty_liver_disease:_A_systematic_review_and_meta_analysis_of_observational_studies_ L2 - https://doi.org/10.1111/hel.12576 DB - PRIME DP - Unbound Medicine ER -