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To eradicate or not? Helicobacter pylori in patients with inflammatory bowel disease: an updated systematic review
Yuzhen Bi1, Limin Zhou1, Shunhai Zhou2
1Department of Gastroenterology, Chun'an County First People's Hospital (Zhejiang Provincial People's Hospital, Chun'an branch), Hangzhou, Zhejiang, China.
Insights
Helicobacter pylori (H. pylori) infection is less common in inflammatory bowel disease (IBD) patients, especially those with Crohn's disease. This finding suggests H. pylori may have an immunomodulatory role in IBD.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- The management of Helicobacter pylori (H. pylori) in inflammatory bowel disease (IBD) patients is complex.
- Standard guidelines recommend H. pylori eradication, but evidence suggests a nuanced relationship with IBD.
Purpose of the Study:
- To critically evaluate the relationship between H. pylori infection and IBD.
- To inform clinical decision-making through an updated systematic review and meta-analysis.
Main Methods:
- A comprehensive literature search of four major databases (PubMed, Embase, Medline, Web of Science) was performed.
- Data from 44 studies (14,100 IBD patients, 291,352 controls) were analyzed using a random-effects model.
- Subgroup, meta-regression, heterogeneity, sensitivity, and publication bias analyses were conducted.
Main Results:
- H. pylori infection prevalence was significantly lower in IBD patients (10.87%) compared to controls (13.48%; OR: 0.43, 95% CI: 0.35-0.53).
- The negative association was stronger in Crohn's disease (OR: 0.36) and Eastern populations (OR: 0.34).
- High heterogeneity (I²=84.93%) was observed, but sensitivity analysis confirmed result robustness; no publication bias was detected.
Conclusions:
- A significant negative association exists between H. pylori infection and IBD, particularly Crohn's disease and in Eastern populations.
- H. pylori may possess an immunomodulatory role in the pathogenesis of IBD.
Background And Aims:
The management of Helicobacter pylori (H. pylori) in patients with inflammatory bowel disease (IBD) presents a common clinical dilemma. While standard guidelines recommend H. pylori eradication to prevent gastric pathology, emerging evidence suggests a potential complex relationship with IBD. This study aims to critically evaluate this relationship through an updated systematic review and meta-analysis to inform clinical decision-making.
Methods:
A comprehensive literature search on four major databases, PubMed, Embase, Medline, and Web of Science, was conducted, and all records before July 10th, 2025, were retrieved for screening. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated using STATA 18 software and a random-effects model (Restricted Maximum Likelihood, REML). Subgroup analyses, meta-regression, heterogeneity, sensitivity, and publication bias analyses were performed.
Results:
Analysis of 44 studies involving 14,100 IBD patients and 291,352 controls revealed a significantly lower prevalence of H. pylori infection in IBD patients compared to controls (13.48% vs. 10.87%; OR: 0.43, 95% CI: 0.35-0.53, p < 0.01). This negative association was particularly strong for Crohn's disease (OR: 0.36, 95%CI: 0.28-0.45) and in Eastern populations (OR: 0.34, 95%CI: 0.26-0.40). Heterogeneity was high (I2 = 84.93%), but sensitivity analysis confirmed the robustness of the findings. No significant publication bias was detected.
Conclusion:
This meta-analysis demonstrates a significant negative association between H. pylori infection and IBD, particularly in patients with Crohn's disease and those of Eastern population. Furthermore, H. pylori may exert a potential immunomodulatory role in IBD.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567688, CRD42024567688.
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