H pylori Is Linked to Reduced Eosinophilic Oesophagitis Risk

TOPLINE: 

Helicobacter pylori infection was associated with decreased odds of eosinophilic oesophagitis, a meta-analysis showed.

METHODOLOGY:

• Researchers conducted an updated meta-analysis of 19 studies involving over 1.7 million individuals to assess the association between H pylori infection and eosinophilic oesophagitis.
• Data were extracted from MEDLINE, Scopus, and ISI Web of Science databases from inception to November 2024.
• Eligible studies included prospective or retrospective observational cohort studies, cross-sectional or longitudinal studies, case-control studies, and clinical trials with data on H pylori status in patients with or without eosinophilic oesophagitis or oesophageal eosinophilia.
• The analysis included studies from various countries, with data collected from both paediatric and adult populations, using different diagnostic methods for H pylori.
• Comparator populations were defined on the basis of histopathological features, with specific eosinophil cut-offs used in various studies to differentiate between patients with eosinophilic oesophagitis or oesophageal eosinophilia and those without.

TAKEAWAY:

• H pylori infection was associated with a 46% reduction in the odds of eosinophilic oesophagitis (odds ratio [OR], 0.54; 95% CI, 0.43-0.67).
• In adults, the odds of eosinophilic oesophagitis were further reduced (OR, 0.46; 95% CI, 0.31-0.67). No significant reduction in the odds of eosinophilic oesophagitis was observed in paediatric patients exposed to H pylori. 
• Compared with overall findings, lower odds of eosinophilic oesophagitis were observed when diagnosis of H pylori was done solely by gastric biopsy (OR, 0.43; 95% CI, 0.25-0.74).
• Subgroup analyses revealed consistent findings across different study designs and geographic locations, with an enhanced protective effect observed in studies published after 2019 (OR, 0.44; 95% CI, 0.28-0.68).

IN PRACTICE:

“The epidemiology of this association may evolve and deserves to be monitored in the future, as well as to be corroborated by further and well-designed population studies,” the authors wrote.

SOURCE:

The study was led by Irene Spinelli and Serena Porcari, Universita Cattolica del Sacro Cuore, Rome, Italy. It was published online on February 24, 2025, in Alimentary Pharmacology & Therapeutics.

LIMITATIONS: 

High heterogeneity was observed among the studies, particularly regarding the overall incidence of eosinophilic oesophagitis or oesophageal eosinophilia among H pylori–exposed patients, warranting caution in interpreting the findings. Data from low-income countries were lacking. Current and past infections could not be distinguished, and differences in the testing strategies for H pylori may have introduced bias.

DISCLOSURES:

This study was supported by grants from the Ricerca Finalizzata Giovani Ricercatori 2018 of the Italian Ministry of Health and the Fondo Italiano per la Scienza 2021 of the Italian Ministry of University and Research. Some authors disclosed receiving speaker fees, advisory board fees, travel grants, or research support from or serving as consultants or advisory board members for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.