Gastroenterology

Gastroenterology

Volume 114, Issue 6, June 1998, Pages 1169-1179
Gastroenterology

Alimentary Tract
Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer

Presented in part in a Topic Forum at the 1996 American Digestive Disease Week in San Francisco, California, and published in abstract form (Gastroenterology 1996;110:A532).
https://doi.org/10.1016/S0016-5085(98)70422-6Get rights and content

Abstract

Background & Aims: Reports in the literature regarding the relationship of Helicobacter pylori infection to gastric cancer are conflicting. The aim of this study was to identify the source of heterogeneity between studies. Methods: Meta-analysis of cohort or case-control studies with age- and/or sex-matched controls, providing raw data on H. pylori infection detected by serology, was used. Results: A fully recursive literature search identified 19 qualified studies with 2491 patients and 3959 controls. Test for homogeneity found a significant difference in odds ratio between patients with early and advanced gastric cancer (6.35 vs. 2.13; P = 0.01), patients with cardiac and noncardiac gastric cancer (1.23 vs. 3.08; P = 0.003), and population- and hospital-based controls (2.11 vs. 1.49; P < 0.001). The summary odds ratio for gastric cancer in H. pylori–infected patients is 1.92 (95% confidence interval [CI], 1.32–2.78), 2.24 (95% CI, 1.15–4.4), and 1.81 (95% CI, 1.16–2.84) for all studies, cohort, and case-control studies, respectively. H. pylori–infected younger patients have a higher relative risk for gastric cancer than older patients with odds ratios decreasing from 9.29 at age ≤29 years to 1.05 at age ≥70 years. H. pylori infection is equally associated with the intestinal or diffuse type of gastric cancer. Conclusions: H. pylori infection is a risk factor for gastric cancer. The heterogeneity of reported results is caused by differences in the selection of controls, patient age, and the site and stage of gastric cancer.

GASTROENTEROLOGY 1998;114:1169-1179

Section snippets

Justification of the systematic review

A MEDLINE search of the English language literature for human studies was performed using textword “Campylobacter pylori” and MeSH term “stomach neoplasms” from 1983 to 1990 and using MeSH terms “Helicobacter pylori, stomach neoplasms” from 1990 to April 1996. A total of 47 relevant reviews was identified. With criteria described by Cook et al.29 and by Greenland30 and with guidelines for the application of meta-analysis in epidemiological studies,31 these were evaluated critically by one of

Peer-reviewed publications

MEDLINE search generated a total of 58 peer-reviewed primary studies for retrieval. However, only 32 studies reported serological testing for H. pylori infection. Manual search identified another three references for a total of 35 potentially relevant articles. Sixteen studies were excluded for various reasons: no matched control group,17, 47, 48, 49, 50, 51, 52 no serological data53 or raw data,54 and same data source.55, 56, 57, 58, 59, 60, 61 Nineteen studies met the predetermined inclusion

Discussion

Since Warren and Marshall first isolated H. pylori from the stomachs of patients with gastritis,62 numerous epidemiological studies and reviews have been published regarding the relationship between H. pylori infection and the development of gastric cancer.13 However, none of the previous reviews has evaluated the literature systematically and statistically with the exception of 1 article by Forman et al.14 To our knowledge, this is the first comprehensive meta-analysis addressing the

Acknowledgements

The authors thank the following original investigators for their generosity in providing primary data on the age distributions of subjects in their studies (names in alphabetical order): Drs. A. Archimandritis, M. Asaka, P. Fidalgo, D. Forman, H. Fukuda, E. J. Kuipers, A. Nomura, J. Parsonnet, J. Rudi, P. Sipponen, N. J. Talley, and P. M. Webb; Dr. J. T. Lin for providing information on their studies; S. Walter and A. Willan for their helpful suggestions on the statistical analysis; and David

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    Address requests for reprints to: Richard H. Hunt, M.D., Division of Gastroenterology, Department of Medicine, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. e-mail: [email protected]; fax: (905) 521-5072.

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