| Background and aims Barrett’s esophagus(BE),a major complication of gastroesophageal reflux disease(GERD),is recognized as the only precancerous lesion of esophageal adenocarcinoma(EAC).Helicobacter pylori(H.Pylori)is a pathogen that can survive in acidic conditions.It is reported that about 50-75% of people in the world are infected with H.pylori.H.pylori infection is a major contributing factor towards upper gastrointestinal diseases,but its relationship with BE remains controversial.On the other hand,hiatal hernia has been recognized as an important pathophysiology of GERD and strongly correlates with BE.However,current guidelines do not publicly recognize hiatal hernia as a risk factor for BE.This meta-analysis aims to determine the clinical significance of H.pylori infection and hiatal hernia on the risk of BE more comprehensively and precisely by combining the most recent evidence.Methods1.The Pub Med,EMBASE,and Cochrane Library databases were searched.The search period was from the establishment of the database to November 11,2021.Odds ratios(ORs)with 95% confidence intervals(CIs)were pooled by a random-effect model.Heterogeneity was evaluated using the Cochran Q test and I2 statistics.Meta-regression,subgroup,and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.2.The Pub Med,EMBASE,and Cochrane Library databases were searched.The search period was from the establishment of the database to October 16,2022.The ORs and adjusted odds ratios(a ORs)with their 95%CIs were calculated for the combined estimation of unadjusted data and data adjusted for confounders,respectively.Heterogeneity was quantified using the Cochrane Q test and I2 statistics.Subgroup,metaregression,and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.Results1.Twenty-four studies with 1,354,369 participants were included.Meta-analysis found that patients with BE had a significantly lower prevalence of H.pylori infection than those without(OR=0.53,95%CI=0.45-0.64,P<0.001).The heterogeneity was statistically significant(I2=79%;P<0.001).Meta-regression,subgroup,and leave-one-out sensitivity analyses did not find any source of heterogeneity.Meta-analysis of 7 studies demonstrated that Cag A-positive H.pylori infection inversely correlated with BE(OR=0.25,95%CI=0.15-0.44,P=0.000),but not Cag A-negative H.pylori infection(OR=1.22,95%CI=0.90-1.67,P=0.206).Meta-analysis of 4 studies also demonstrated that H.pylori infection inversely correlated with LSBE(OR=0.39,95%CI=0.18-0.86,P=0.019),but not SSBE(OR=0.73,95%CI=0.30-1.77,P=0.484).2.Forty-seven studies with 131,517 participants were included.Based on the unadjusted data from 47 studies,hiatal hernia was significantly associated with an increased risk of any length BE(OR=3.91,95%CI=3.31-4.62,P<0.001).The heterogeneity was significant(I2=77%;P<0.001)and the definition of controls(P=0.014)might be a potential contributor to heterogeneity.This positive association remained based on the adjusted data from 14 studies(a OR=3.26,95%CI=2.44-4.35,P<0.001).The heterogeneity was also significant(I2=65%;P<0.001).Meta-analysis of seven studies demonstrated that hiatal hernia was significantly associated with an increased risk of long-segment BE(LSBE)(OR=10.01,95%CI=4.16-24.06,P<0.001).The heterogeneity was significant(I2=78%;P<0.001).Meta-analysis of seven studies also demonstrated that hiatal hernia was significantly associated with an increased risk of short-segment BE(OR=2.76,95%CI=2.05-3.71,P<0.001).The heterogeneity was not significant(I2=30%;P=0.201).ConclusionsH.pylori infection negatively correlates with BE,while hiatal hernia is a significant risk factor for BE.More large-scale prospective cohort studies are required to confirm our findings in future. |
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