Helicobacter pylori infection and risk of multiple sclerosis: An updated meta‐analysis

• Published in: Helicobacter (Cambridge, Mass.) Mass.), 2022-12, Vol.27 (6), p.e12927-n/a
• Main Authors: Arjmandi, Delaram, Abdollahi, Ali, Ardekani, Ali, Razavian, Iman, Razavian, Elnaz, Sartip, Behnam, Mahjour, Sanaz, Parsa, Hamid, Kyvanani, Nastaran Azizi, Marhoommirzabak, Elika, Kountouras, Jannis, Rostami, Ali
• Format: Article
• Language: English
• Subjects: association; Confidence intervals; Datasets; Diagnostic systems; Health risks; Helicobacter pylori; Heterogeneity; Immunoglobulin G; Infections; Meta-analysis; Multiple sclerosis; Regression analysis; Risk analysis; Risk factors; Statistical analysis; Subgroups
• ISSN: 1083-4389; 1523-5378
• DOI: 10.1111/hel.12927

Background There is considerable controversy around the question as to whether Helicobacter pylori (H. pylori) infection has a protective or causative role in the development of multiple sclerosis (MS). This study evaluated published information to assess the association between H. pylori infection and MS. Methods We conducted a comprehensive systematic review of relevant observational studies in international databases. A random‐effects model was used to calculate pooled odds ratio (OR) and 95% confidence interval (CI). I2 statistic was used to assess the between‐study heterogeneity. Subgroup and meta‐regression analyses were applied to identify the source of heterogeneity. Results In total, 22 studies (25 datasets) were eligible for the meta‐analysis: 17 datasets had prevalence data and eight datasets had data on the mean titer of anti‐H. pylori IgG. The pooled prevalence of H. pylori was 44.1% (908/2606) in the MS patients and 46.1% (1016/2200) in the controls, indicating a non‐significant protective effect of H. pylori on MS (OR, 0.82; 95%CI, 0.58–1.17). In the subgroup analysis, studies that used ELISA yielded a significant protective association (OR, 0.59; 95%CI, 0.46–0.77), while a positive non‐significant association (OR, 1.33; 95%CI, 0.83–2.15) was found from studies that used other serological methods; interestingly, a significant positive association (OR, 6.64; 95%CI, 2.40–13.76) was found from studies that used histological methods to detect H. pylori infection. Conclusions Our findings do not support the hypothesis that H. pylori infection represents a protective factor against the development of MS; however, the results varied depending on the diagnostic method(s). Particularly, a significant positive association was identified when studies introduced results based on histological examination, suggesting that active H. pylori infection might be a risk factor for development of MS. Thus, further studies are needed utilizing accurate diagnostic methods to elucidate the association between active H. pylori infection and MS.