Barrett食管患者幽门螺杆菌感染率的Meta分析

Prevalence of Helicobacter Pylori in Patients with Barrett's Esophagus:A Meta-analysis

目的分析Barrett食管患者幽门螺杆菌感染率及cagA阳性的幽门螺杆菌感染率,并与内镜检查正常者和胃食管反流病患者比较,探讨幽门螺杆菌(Helicobacter pylori,Hp)感染与Barrett食管的关系。方法计算机检索MEDLINE和EMbase数据库至2008年2月,纳入比较Barrett食管患者和内镜检查正常者及胃食管反流病(gastroesophageal reflux disease,GERD)患者Hp感染率的病例对照研究或队列研究。统计分析采用RevMan4.2.8,计算比值比OR(95%CI)。结果共纳入19篇文献,包括16篇病例对照研究和3篇队列研究。病例对照研究分析结果显示,Barrett食管患者比内镜检查正常者Hp感染率低[OR0.56,95%CI(0.40,0.79)],与GERD患者相比差异无统计学意义[OR0.86,95%CI(0.74,1.00)]。队列研究的分析结果显示,Barrett食管患者与内镜检查正常者及GERD患者相比Hp感染率差异无统计学意义[OR1.12,95%CI(0.77,1.61);OR1.10,95%CI(0.32,3.83)]。cagA阳性Hp感染率较内镜正常者及GERD患者低[OR0.30,95%CI(0.12,0.74);OR0.55,95%CI(0.33,0.94)]。病例对照研究长节段较短节段Barrett食管Hp感染率低[OR0.32,95%CI(0.16,0.66)]。而队列研究结果显示,长节段较短节段Barrett食管患者Hp感染率差异无统计学意义[OR0.66,95%CI(0.29,1.48)]。结论Barrett食管患者和GERD患者Hp感染率无差别,Barrett食管患者Hp感染率,特别是cagA阳性Hp菌株感染率较内镜检查正常者明显减少。

Objective We aimed to evaluate the prevalence of H.pylori infection and the prevalence of cagA＋ strains in patients with and without Barrett＇s esophagus. Methods A full literature search to February 2008 was conducted in PubMed, MEDLINE and EMbase databases to identify case-control studies or cohort studies evaluating the prevalence of H.pylori in patients with or without Barrett＇s esophagus. Summary odds ratios （OR） and 95% confidence interval （CI） were calculated by RevMan 4.2.8. Results Nineteen studies were identified （16 case-controlled studies and 3 cohort studies）. In case controlled studies, the prevalence of H.pylori infection significantly decreased in patients with Barrett＇s esophagus as compared subjects with normal endoscopic appearance, with a overall OR of 0.56 （95%CI 0.40 to 0.79）. The prevalence of H.pylori infection was no statistically significant difference in patients with Barrett＇s esophagus as compared to those with gastroesophageal reflux disease, with a overall OR of 0.86 （95% CI 0.74 to 1.00）. In cohort studies, the prevalence of H. pylori was no statistically significant difference in patients with Barrett＇s esophagus as compared to patients with normal endoscopic appearance or patients with gastroesophageal reflux disease, with a overall OR of 1.12 （95%CI 0.77 to 1.61） and 1.10 （95%CI 0.32 to 3.83）. When the analysis was stratified by the status of cagA, the prevalence of cagA positive strains significantly decreased in patients with Barrett＇s esophagus as compared both to subjects with normal endoscopic appearance with OR 0.30 and 95% CI 0.12 to 0.74, and to those with gastroesophageal reflux disease （OR 0.55; 95%CI 0.33 to 0.94）. Irrespective of the presence of intestinal metaplasia, similar magnitude for the reduction of H.pylori infection was observed for patients with Barrett＇s esophagus and those with normal endoscopic appearance. While accompared with the presence of intestinal metaplasia, Barrett＇s esophagus was associated with a significantly reduction as compared to the patients with gastroesophageal reflux disease （OR 0.81, 95%CI 0.68 to 0.98）. When stratified analyses were performed, a significant reduction of H.pylori infection was observed only in patients with long-segment Barrett＇s esophagus （OR 0.54; 95%CI 0.35 to 0.82）, but not in those with short-segment Barrett＇s esophagus （OR 0.72; 95%CI 0.43 to 1.20）. Conclusion This meta-analysis indicated that the prevalence of H.pylori infection, especially the prevalence of cagA positive strains was significantly lower in patients with Barrett＇s esophagus than in subjects with normal endoscopic appearance. However, the prevalence of H. pylori infection was no statistical difference in patients with Barrett＇s esophagus as compared to those with gastroesophageal reflux disease. Colonization with cagA positive strains may be protective against the formation of Barrett＇s esophagus.