The Role of Breast-Feeding in the Prevention of Helicobacter pylori Infection: A Systematic Review

• Published in: Clinical infectious diseases 2009-02, Vol.48 (4), p.430-437
• Main Authors: Chak, Eric, Rutherford, George W., Steinmaus, Craig
• Format: Article
• Language: English
• Subjects: Articles and Commentaries; Bacteria; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Breast Feeding; Breast milk; Breastfeeding & lactation; Children; Developing Countries; Disease prevention; Epidemiology; Female; Helicobacter Infections - epidemiology; Helicobacter Infections - prevention & control; Helicobacter pylori; Helicobacter pylori - immunology; Human bacterial diseases; Humans; Infections; Infectious diseases; Medical sciences; Meta analysis; Mothers; Protective effects; School age children; Statistical significance; Systematic review
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/596499

Background. The benefits of breast-feeding for the prevention of infection in infants and young children have been widely recognized, but epidemiologic studies regarding the role of breast-feeding in protecting against Helicobacter pylori infection have produced conflicting results. Methods. We performed a systematic review of relevant epidemiologic studies conducted during the period 1984–2007 after abstracting data from articles that met our inclusion criteria. Study quality was assessed using the Newcastle-Ottawa scale. With use of the random effects model, we calculated the summary odds ratios (ORs) and 95% confidence intervals (CIs) for H. pylori infection according to history of breast-feeding. Results. For the 14 studies that met inclusion criteria, the summary OR for H. pylori infection was 0.78 (95% CI, 0.61–0.99; 1-sided P=.02). Nine of the 14 studies reported ORs of 1.0. In studies in which the subjects resided in middle- or low-income nations, the summary OR was 0.55 (95% CI, 0.33–0.93; P=.01), compared with 0.93 (95% CI, 0.73–1.19; P=.28) in studies in which subjects resided in high-income nations. The summary OR for studies that use the >13C-urea breath test was 0.67 (95% CI, 0.32–1.39), compared with 0.91 (95% CI, 0.74–1.11) for studies that used the H. pylori IgG serologic test. We found no statistically significant dose-dependent protective effect against H. pylori associated with increasing duration of breast-feeding. Conclusions. Breast-feeding is protective against H. pylori infection, especially in middle- and low-income nations.