Helicobacter pylori And Duodenal Ulcer: Systematic Review Of Controversies In Causation

Figures & data

Figure 1 Data searching process.

Table 1 Study Characteristics Of Reviewed Articles

No	Author	Study Design	Sample Size	Year	Country	Method	Result
1	Carrick J, Lee A, Hazell S, Ralston M, Daskalopoulos G	Cohort	137	1989	Australia	Congo Red staining	Strong risk factor (RR=51)^Citation21
2	Moss SF, Calam J	Randomized clinical trial	9	1993	England	Endoscopy and biopsies	Eradication reduce basal plasma gastrin concentration (P<0.05), and basal acid secretion (P<0.01)^Citation39
3	Reinbach DH, Cruickshank G, McColl KE	Matched hospital case control	80	1993	United Kingdom	Serum anti-H pylon IgG and ‘4C-urea breath tests	Prevalence 47%^Citation32
4	Batista SA, et al	Experimental	112	2011	Brazil	Endoscopy	Number of EPIYA C segments did not associate with duodenal ulcer^Citation41
5	Cekin AH, et al	Matched case control	222	2012	Turkey	Esophago-gastroduodenoscopy	H. pylori located in the corpus [OR]=3.00; incisura OR=2.07; and antrum [OR]=2.71. Hp positivity was 84.9%^Citation27
6	Gisbert JP, et al	Cross-sectional	774	1999	Spain	Endoscopy	Prevalence 95.3%^Citation34
7	Tsuji H, et al	Cross-sectional	120	1999	Japan	Endoscopic, rapid urease test and forceps biopsies	1.7% H. pylori-negative rates^Citation12
8	Gdalevich M, et al	Nested case control	29	2000	Israel	ELISA IgG-Ab	OR=3.8^Citation31
9	Khan MM, Shahzed MN, Jibran M, Rabbani MJ	Cross-sectional	116	2009	Pakistan	ACON®	116 patients (92 males and 24 females) have perforated DU and more common in 30–50 age groups^Citation48
10	Lario S, et al	Cohort	88	2013	Spain	Microarrays	Higher levels of IL8 and IL12p40 mRNAs and lower levels of GATA6 and SOCS2 mRNAs^Citation49
11	Labenz JO, et al	Cross-sectional	16	1996	Germany	pH metry, glass electrode, urea breath test, culture, histology, and rapid urease	H. pylori eradication decrease the pH-increasing effect of omeprazole; P<0.002^Citation36
12	Olbe L, Hamlet A, Dalenback J, Fandriks L	Cross-sectional	16	1996	Sweden	Urea breath test, culture, histology, and rapid urease	Inhibitory mechanism was restituted in 8 of 10 patients within 9 months after eradication of H. pylori infection^Citation5
13	Chu KM, Kwok KF, Law S, Wong KH	Cross-sectional	1343	2005	China	Endoscopic, rapid urease test and biopsies	Male preponderance (M:F=2.5:1)^Citation13
14	Syam AF, et al	Cross-sectional	267	2014	Indonesia	Culture, histology and rapid urease test	Prevalence 22.1%^Citation10
15	Segal ED, Cha J, Lo J, Falkow S, Tompkins LS	Laboratory		1999	USA	ELISA IgG-Ab	145-kDa protein and activation of signal transduction pathways associated with the attachment of H. pylori^Citation19
16	Borody TJ, et al	Cohort	302	1991		Endoscopic, rapid urease test and biopsies	94% were found to have associated H pylori^Citation44
17	Ng EK, et al	Cohort	73	1996		Intra-operative gastroscopy and antral biopsies	70% had evidence of H. pylori^Citation33
18	Rauws EA, Tytgat GN	Randomized clinical trial	50	1990			Eradication achieved 7 of the 45 patients and there was no ulcer relapse during the first 12 months of follow-up^Citation38
19	Patchett S, Beattie S, Leen E, Keane C, O’Morain C	Cohort	51	1992		Endoscopic, biopsies	Recurrence of H. pylori infection occurred in 35.3%^Citation29
20	Chan FK	Randomized clinical trial	100	1997	Hong Kong	Endoscopy	Eradication of H pylori before NSAID therapy reduces the occurrence^Citation16
21	Blaser MJ, Chyou PH, Nomura A	Case control	313	1995	USA		H. pylori do not increases risk of developing duodenal ulcer^Citation40
22	Nomura A, Stemmermann GN, Chyou PH, Perez-Perez GI, Blaser MJ	Nested case control	5443	1994	USA	ELISA IgG-Ab	92% patients and 78% of the matched controls had a positive test result, OR=4.0^Citation28
23	Kim JG, Graham DY	Cross-sectional	181	1994		ELISA IgG-Ab	36% developed a duodenal ulcer^Citation45
24	Borody TJ, Brandl S, Andrews P, Jankiewicz E, Ostapowicz N	Cross-sectional	115	1992	Australia	Endoscopy	47 (66%) no detectable causal factors, 21 (30%) regularly taking NSAIDs, and three (4%) had malignant GU^Citation17
25	Bytzer P, Teglbjærg PS, Group DU	Randomized clinical trial	276	2001		Culture, immunohistochemistry, and urea breath test	Eradication therapy over 2 years is significantly poorer in H. pylori-negative patients^Citation7
26	Escobar MA, et al	Cross-sectional	169	2004			12% of patients develop late complications^Citation26

Table 2 Hill Criteria For Assessing The Causal Role Of H. Pylori On Duodenal Ulcer

Sr. No	Hill Criteria’s	Description
1	Biological plausibility	Biologically plausible explanations for causation exist.^Citation18^–^Citation20
2	Dose response relationship	Eradication of H. pylori infection decreases the incidence of duodenal ulcer and prevents its recurrence.^Citation22,Citation35^–^Citation37,Citation39
3	Strength of association	Strong association.^Citation21,Citation28,Citation29
4	Consistency	The association between H. pylori and duodenal ulcer has been consistently demonstrated in a number of different types of epidemiological studies (ecological, case-control, cohort, randomized clinical trial and cross-sectional).
5	Temporality	Proved in epidemiological studies (case-control, cohort, randomized clinical trial)
6	Study design	All types of epidemiological study designs (ecological, case-control, cohort, randomized clinical trial, and cross-sectional).
7	Reversibility	The removal of a possible cause (H. pylori) led to reduction of disease risk.^Citation22,Citation35^–^Citation37,Citation39
8	Specificity of association	No, exposure to H. pylori is also associated with other diseases like gastric ulcer,^Citation31,Citation40 gastric cancer,^Citation28,Citation41 gastro esophageal reflex disease.^Citation25

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