Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7392.737 (Published 05 April 2003) Cite this as: BMJ 2003;326:737
- Anan Raghunath, honorary research fellow (raghu{at}nath.freeserve.co.uk)a,
- A Pali S Hungin, professor of primary care and general practicea,
- David Wooff, directorb,
- Susan Childs, research associatec
- a Centre for Integrated Health Care Research, Wolfson Research Institute, University of Durham, Stockton on Tees TS17 6BH
- b Department of Mathematical Sciences, Statistics and Mathematics Consultancy Unit, University of Durham, Science Laboratories, Durham DH1 3LE
- c Information Management Research Institute, School of Information Studies, University of Northumbria, Newcastle upon Tyne NE1 8ST
- Correspondence to: A Raghunath
- Accepted 5 February 2003
Abstract
Objectives: To ascertain the prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease and its association with the disease.
Design: Systematic review of studies reporting the prevalence of H pylori in patients with and without gastro-oesophageal reflux disease.
Data sources: Four electronic databases, searched to November 2001, experts, pharmaceutical companies, and journals.
Main outcome measure: Odds ratio for prevalence of H pylori in patients with gastro-oesophageal reflux disease.
Results: 20 studies were included. The pooled estimate of the odds ratio for prevalence of H pylori was 0.60 (95% confidence interval 0.47 to 0.78), indicating a lower prevalence in patients with gastro-oesophageal reflux disease. Substantial heterogeneity was observed between studies. Location seemed to be an important factor, with a much lower prevalence of H pylori in patients with gastro-oesophageal reflux disease in studies from the Far East, despite a higher overall prevalence of infection than western Europe and North America. Year of study was not a source of heterogeneity.
Conclusion: The prevalence of H pylori infection was significantly lower in patients with than without gastro-oesophageal reflux, with geographical location being a strong contributor to the heterogeneity between studies. Patients from the Far East with reflux disease had a lower prevalence of H pylori infection than patients from western Europe and North America, despite a higher prevalence in the general population.
What is already known on this topic
What is already known on this topic The relation between H pylori infection and gastro-oesophageal reflux disease is controversial
Studies on the prevalence of H pylori in patients with gastro-oesophageal reflux disease have given conflicting results
Recent guidelines recommend eradication of H pylori in patients requiring long term proton pump inhibitors, essentially for reflux disease
What this study adds
What this study adds Despite heterogeneity between studies, the prevalence of H pylori was significantly lower in patients with than without gastro-oesophageal reflux disease
Further well designed studies are required to establish the clinical relevance of the findings, particularly in eradication therapy
Footnotes
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Funding The Northern and Yorkshire NHS Executive (research and development) funded this review through a regional research fellowship to AR. Abbott Pharmaceuticals provided additional financial support. This review is a part of AR's PhD.
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Competing interests APSH is coauthor of the Maastricht 2 guidelines on the management of H pylori infection; he has received research funding from Abbott Pharmaceuticals and conference travel costs and honoraria for advisory groups to several manufacturers of proton pump inhibitors over the past five years. AR has received research funding from Wyeth.
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Details of the searches and tables of the excluded studies and prevalences appear on bmj.com
- Accepted 5 February 2003