Helicobacter pylori infection in patients with chronic obstructive pulmonary disease. A systematic review and meta-analysis.

Abstract

Objective: To determine the association of HP infection with COPD, assessing its prevalence and influence on symptoms, lung function, quality of life, exacerbations, hospitalizations, mortality, and healthcare costs.

Methods: We performed a systematic review and meta-analysis after conducting a systematic literature search in PubMed, Embase, Cochrane Library, Virtual Health Library, ScienceDirect, Scopus, Researchgate, and GoogleScholar, from database inception to 31/12/2022. We used the Der Simonian-Laird method to calculate pooled HP prevalence, the Mantel-Haenszel model to determine the association of HP with COPD, and the inverse variance method to compare the pulmonary function tests between infected and uninfected patients, always with a fixed-effect model.

Results: Twenty-eight studies included a total of 8647 patients with COPD. The pooled prevalence of HP infection was 29.8% (95%CI 29.0-30.7%). The more severe stage of COPD lesser the prevalence of HP (p < 0.001). HP infection was associated with COPD, estimated odds ratio 1.90 (95%CI 1.71, 2.12), p < 0.001. The mean differences for p%FEV₁, p%FVC and FEV₁/FVC ratio between HP infected and uninfected patients with COPD were -13.06 (95%CI -14.54, -11.58), -3.72 (95%CI -5.64, -1.79) and -0.01 (95%CI -0.02, -0.00) respectively.

Conclusion: Our meta-analysis suggests an appreciable relationship between HP infection and COPD. Further longitudinal studies considerating confounders and investigating causality are required.