Halitosis and Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Halitosis, a common clinical condition, is frequently associated with Helicobacter pylori infection. Numerous studies have highlighted a significant reduction in halitosis following successful H. pylori eradication.

This meta-analysis aimed to investigate the association between H. pylori infection and halitosis, as well as the effect of H. pylori eradication on halitosis resolution.

We searched major databases, including PubMed, EMBASE, the Cochrane Library, and the Science Citation Index, up to March 2025. Literature screening and data extraction were conducted according to strict inclusion and exclusion criteria. Study quality was assessed using appropriate tools according to study design. Heterogeneity and risk of bias were analyzed using Stata 12.0. Subgroup analyses were performed to examine the relationship between H. pylori infection and halitosis, including infection prevalence, symptom incidence, and treatment outcomes.

Of the 154 articles screened, 24 met the inclusion criteria, involving 5872 patients. The analysis revealed a significantly higher H. pylori infection rate in the halitosis group compared with the non-halitosis group (OR = 3.42; 95% CI: 1.13-10.33). The prevalence of halitosis was higher in H. pylori-positive individuals than in H. pylori-negative individuals (OR = 1.91; 95% CI: 1.28-2.86). The prevalence of halitosis was lower in the successful eradication group compared with the unsuccessful eradication group (OR = 0.17; 95% CI: 0.04-0.73). Moreover, pre-eradication halitosis rates were higher than post-eradication rates (OR = 4.39; 95% CI: 1.99-9.68).

The findings suggest a significant observational association between H. pylori infection and halitosis, and eradication therapy may be associated with alleviation of halitosis.