A Systematic Review and Meta-analysis for Association of Helicobacter pylori Colonization and Celiac Disease

Abstract

Background and objectivesBased on some previous observational studies there is a theory that suggests a potential relationship between Helicobacter pylori (H. pylori) colonization and celiac disease (CD), however, the type of this relationship is still controversial. Therefore, we aimed to conduct a systematic review and meta-analysis to explore all related primary studies to find any possible association between CD and human H. pylori colonization. Data sourcesStudies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After screening, the quality and risk of bias assessment of the selected articles were evaluated. Synthesis methodsMeta-analysis calculated pooled odds ratio (OR) on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed. ResultsTwenty-four studies were included in this systematic review, with a total of 5241 cases and 132947 control people. The results of meta-analysis on 24 studies showed a significant and negative association between H. pylori colonization and CD (pooled OR= 0.58; 95% CI = 0.45 - 0.76; P < 0.001), with no publication bias (P = 0.407). The LAbbe plots also showed a trend of having more H. pylori colonization in the control group. Among subgroups, ORs were notably different only when the data were stratified by continents or risk of bias; however, subgroup analysis could not determine the source of heterogeneity. ConclusionsAccording to the meta-analysis, H. pylori has a mild protective role toward CD. Although this negative association is not strong, it is statistically significant and should be further considered. Further investigations in both molecular and clinic fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of H. pylori colonization in CD patients. Systematic review registration number (PROSPERO)CRD42020167730