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Association between cirrhosis and Helicobacter pylori infection: a meta-analysis

Feng, Haoa,b,*; Zhou, Xiaoyinga,*; Zhang, Guoxina

European Journal of Gastroenterology & Hepatology: December 2014 - Volume 26 - Issue 12 - p 1309–1319
doi: 10.1097/MEG.0000000000000220
Review Article

Cirrhosis is a severe threat to public health. Some studies have suggested that cirrhosis is associated with Helicobacter pylori infection, but the results remain controversial. This meta-analysis was conducted to quantify the association between cirrhosis and H. pylori infection. Published articles on H. pylori prevalence in patients with cirrhosis were collected to assess the potential associations between H. pylori infection and cirrhosis risk. Twenty-one eligible studies were included for the analysis. Data on publication year, geographic region, and etiology were summarized. Metaregression models and subgroup analyses were established to screen the factors for heterogeneity. Of the 322 articles retrieved, 21 met the inclusion criteria. These studies involved 6135 cases, with a total H. pylori infection rate of 52.26%. This meta-analysis showed significant difference in H. pylori infection between patients with cirrhosis and controls [odd ratio (OR)=2.05, 95% confidence interval (CI): 1.33–3.18, P<0.0001]. The subgroup analysis revealed, in contrast to Asia (OR=0.90, 95% CI: 0.48–1.66, P<0.0001), Europe (OR=2.98, 95% CI: 2.02–4.39, P<0.0001), and America (OR=4.75, 95% CI: 1.42–15.95, P=0.249), a significantly higher prevalence of H. pylori infection in patients with cirrhosis. On the basis of etiology, there was a higher prevalence of H. pylori infection due to primary biliary cirrhosis (OR=1.75, 95% CI: 1.15–2.64, P=0.147) and viral cirrhosis (OR=2.66, 95% CI: 1.24–5.71, P<0.0001) compared with alcohol cirrhosis (OR=0.77, 95% CI: 0.04–16.59, P<0.0001). The pooled data suggest that there is a significantly high prevalence of H. pylori infection in patients with cirrhosis. Large-scale and multicenter studies are needed to further investigate the relation between cirrhosis and H. pylori infection.

aDepartment of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, First Clinical Medical College of Nanjing Medical University

bNanjing Jiangbei People’s Hospital, Nanjing, China

* Hao Feng and Xiaoying Zhou contributed equally to the writing of this article.

Correspondence to Guoxin Zhang, PhD, MD, Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China Tel: +86 25 83718836 x6973; fax: +86 25 83674636; e-mail:

Received May 14, 2014

Accepted September 4, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins