Helicobacter pylori infection and multiple sclerosis: an updated meta-analysis
Helicobacter pylori infection and multiple sclerosis: an updated meta-analysis
Delaram Arjmandi,1Ali Ardekani,2Iman Razavian,3Elnaz Razavian,4Ali Rostami,5,*
1. Babol University of Medical Sciences 2. School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 3. Department of Neurosurgery, Functional Neurosurgery Research Center, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4. Department of Neurology, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran 5. Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
Introduction: 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 significant positive association (OR, 5.75; 95%CI, 2.40–13.76) was found in studies that used histological methods.
Conclusion: 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). Further studies are needed utilizing accurate diagnostic methods to elucidate the association between active H. pylori infection and MS.