| BackgroundHelicobacter pylori(H.pylori,Hp)is a major risk factor for many important upper gastrointestinal diseases,such as chronic gastritis,peptic ulcer,gastric mucosa associated lymphoid tissue lymphoma,stomach,etc.,with its many outside the gastrointestinal diseases,including diabetes,also have particular concern,more and more scholars found that people with diabetes for H.pylori exist generally.Previous studies have found that the presence of diabetes generally reduces the effectiveness of antibiotics in the treatment of infectious diseases.However,whether diabetes reduces the rate of Hp eradication has not been determined,and the controversy remains.Therefore,we conducted this meta-analysis to investigate the impact of diabetes on the risk of helicobacter pylori eradication failure.ObjectivesThe risk of eradication failure of H.pylori infection in diabetic patients was systematically evaluated and the quality of evidence was assessed.MethodsInclusion and exclusion criteria for meta analysis were formulated,and data published before December 31,2018 on patients with diabetes and control group H were collected by computer retrieval from MEDLINE,Cochrane library,VIP,wanfang data knowledge service platform and cnki database.Studies on eradication have failed.Data extraction and literature quality evaluation were carried out independently by two researchers.The modified newscal-ottawa Scale(NOS)was used for literature quality evaluation,and STATA software(Version 14.0.STATA Corporation,College Station,TX,US)conducted statistical analysis on the data,and used GRADE pro version 3.6 software to comprehensively evaluate the quality of the combined evidence.Results(1)A total of 17 articles(18 studies)met the inclusion criteria(a total of 2,157subjects,of whom 1,056 were diabetic).Overall,the total eradication failure rate was 38%(402/1056)in diabetic patients and 15%(168/1101)in non-diabetic patients.The pooled risk ratio(RR)of Hp eradication failure in diabetic patients was 2.49(95%ci:2.12~2.91)compared with that in non-diabetic patients(P<0.0001).The heterogeneity test showed that there was no significant difference between the included studies,which was low grade heterogeneity(I~2=23.9%,P=0.172).Publication bias was not statistically significant by Egger Test(P=0.165)and Begg Test(Pr>|z|=0.622,|z|=0.45).(2)Subgroup analysis:we conducted subgroup analysis on several key research characteristics(diabetes type,region,radical treatment,evaluation method,glycosylated hemoglobin value and characteristics of digestive tract lesions)to explore the source of heterogeneity.The effect of diabetes on the high risk of successful eradication failure was consistently observed in different subgroups.(3)The GRADE evaluation system was used to evaluate the combined analysis evidence of the risk of Hp eradication failure in patients with diabetes.Based on large-effect factors,the evidence quality(large+)of the upgrade evaluation was considered as medium quality evidence.ConclusionsThe current meta-analysis confirmed that the risk of failure in Hp eradication in diabetic patients was higher than that in non-diabetic patients,suggesting that it is necessary to extend the treatment time or develop new Hp eradication schemes for diabetic patients,and the level of evidence was of medium quality. |
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