Meta‐analysis: the relationship between Helicobacter pylori infection and gastro‐oesophageal reflux disease

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Abstract
Background: The relationship between Helicobacter pylori infection and its treatment and gastro‐oesophageal reflux disease (GERD) is controversial. Aims: To establish if H. pylori infection is associated with the presence of GERD and if anti‐H. pylori treatment leads to de novo GERD or rebound/exacerbation of GERD. Methods: A search of MEDLINE and EMBASE databases was made. Pooled odds ratios (OR) were calculated for de novo GERD and rebound/exacerbated GERD after anti‐H. pylori therapy in case‐control studies and in therapeutic trials. Results: Fourteen case‐control studies and 10 clinical trials were included. Among case‐control studies, pooled OR for the association between H. pylori negative status and GERD was 1.34 [95% confidence interval (CI) 1.15–1.55]. Among therapeutic trials, pooled OR for the association anti‐H. pylori therapy – GERD was 2.54 (95% CI 1.92–3.37). The OR for de novo GERD was 3.25 (95% CI 2.09–5.33), and for rebound/exacerbated GERD was 2.39 (95% CI 1.75–3.34). Associations were higher among Asian studies than among North American and European studies. Conclusions: This meta‐analysis shows significant association between absence of H. pylori infection and GERD symptoms, and a positive association between anti‐H. pylori therapy and occurrence of both de novo and rebound/exacerbated GERD. The significance of these associations appears to have been inflated by the effect of single trials and by geographical variations.