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The relationship between inflammatory bowel disease and Helicobacter pylori across East Asian, European and Mediterranean countries: a meta-analysis

Lookup NU author(s): Dr Michaela Goodson



This is the final published version of an article that has been published in its final definitive form by Hellenic Society of Gastroenterology, 2020.

For re-use rights please refer to the publisher's terms and conditions.


Background The current literature suggests a protective benefit of Helicobacter pylori (H. pylori) infection against inflammatory bowel disease (IBD). Here we assessed whether this effect varied by IBD subtype—Crohn’s disease (CD) or ulcerative colitis (UC)—and geographic region: East Asia, Europe (non-Mediterranean) or Mediterranean region. Methods A database search was performed up to July 2019 inclusive for all studies that compared H. pylori infection in IBD patients vs. non-IBD controls. The relative risk (RR) was used to quantify the association between IBD and H. pylori, and the effects were combined across studies using a mixed-effects meta-regression model, which included IBD subtype and geographic region as categorical moderator variables. Results Our meta-regression model exhibited moderate heterogeneity (I2=48.74%). Pooled RR depended on both region (P=0.02) and subtype (P<0.001). Pooled RRs were <1 for all subtype and region combinations, indicative of a protective effect of H. pylori against IBD. The pooled RR was 28% (9%, 50%; P=0.001) greater for UC vs. CD and 43% (4%, 96%; P=0.02) greater for Mediterranean countries vs. East Asia. The pooled RR was 18% (-13%, 60%; P=0.48) greater for Europe vs. East Asia and 21% (-13%, 68%; P=0.42) greater for Mediterranean vs. Europe, though these differences were not statistically significant. Conclusions The protective effect of H. pylori on IBD varied by both subtype (more protection against CD vs. UC) and region (East Asia more protected than Mediterranean regions). Variation due to these effects could provide insight into IBD etiology. © 2020 Hellenic Society of Gastroenterology.

Publication metadata

Author(s): Imawana RA, Smith DR, Goodson ML

Publication type: Article

Publication status: Published

Journal: Annals of Gastroenterology

Year: 2020

Volume: 33

Issue: 5

Pages: 485-494

Online publication date: 06/06/2020

Acceptance date: 06/05/2020

Date deposited: 28/03/2022

ISSN (print): 1108-7471

ISSN (electronic): 1792-7463

Publisher: Hellenic Society of Gastroenterology


DOI: 10.20524/aog.2020.0507

PubMed id: 32879595


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