Helicobacter pylori infection is not associated with portal hypertension-related gastrointestinal complications: A meta-analysis

Despite the importance ofHelicobacter pyloriinfection and portal hypertension (PH)-associated gastrointestinal (GI) diseases, such as esophageal varices and portal hypertensive gastropathy (PHG), the impact ofH.pyloriinfection on PH-related GI complications has not yet been elucidated. This meta-analysis investigated the association betweenH.pyloriinfection and the risk of PH-related GI complications. An electronic search for original articles published before May 2020 was performed using PubMed, EMBASE, and the Cochrane Library. Independent reviewers conducted the article screening and data extraction. We used the generic inverse variance method for the meta-analysis, and Begg’s rank correlation test and Egger’s regression test to assess publication bias. A total of 1,148 cases ofH.pyloriinfection and 1,231 uninfected controls were included from 13 studies.H.pyloriinfection had no significant association with esophageal varices [relative risk (RR) = 0.96, 95% confidence interval (CI) = 0.87–1.06 for all selected studies; RR = 0.95, 95% CI = 0.84–1.07 for cohort studies; odds ratio (OR) = 0.96, 95% CI = 0.60–1.54 for case-control studies]. AlthoughH.pyloriinfection was significantly associated with PHG in case-control studies [OR = 1.86, 95% CI = 1.17–2.96], no significant differences were found in the cohort studies [RR = 0.98, 95% CI = 0.91–1.05] or all studies combined [RR = 1.18, 95% CI = 0.93–1.52]. In conclusion,H.pyloriinfection was not associated with the risk of PH-related GI complications. Clinicians should carefully treat cirrhotic patients with PH-related GI complications, regardless ofH.pyloriinfection.