Meta-Analysis: Inverse Association Between Helicobacter pylori Infection and Eosinophilic Oesophagitis

Background: Exposure to Helicobacter pylori (H. pylori) has been associated with a decreased risk of eosinophilic oesophagitis (EoE). Aim: The aim of this study is to determine the association between H. pylori infection and EoE in this updated meta-analysis. Methods: We searched MEDLINE, Scopus and ISI Web of Science, through to November 2024. We included studies reporting the status of H. pylori infection in patients with and without EoE or oesophageal eosinophilia (EE). We used a random-effects model to pool estimates. Results: We analysed 19 studies including 1.704.821 subjects. H. pylori infection was associated with a 46% lower risk of EoE/EE (OR: 0.54, 95% CI 0.43 to 0.67). Comparable findings were observed when subgrouping studies by location or design. There was a nonsignificant decrease in odds for EoE in paediatric patients exposed to H. pylori (OR 0.57, 95% CI 0.26 to 1.24), and in studies using serology to diagnose H. pylori (OR: 0.41, 95% CI 0.16 to 1.04). We found lower odds of EoE compared with the overall findings in studies that diagnosed H. pylori only by gastric biopsy (OR 0.43, 95% CI 0.25 to 0.74) and in those published after 2019 (OR 0.44, 95% CI 0.28 to 0.68). Conclusions: Exposure to H. pylori was significantly associated with decreased odds of EoE/EE. As a stronger protective effect was found in more recent studies, the epidemiology of this association may evolve and deserve to be further monitored.