| Objective: The effect of Helicobacter pylori(H.pylori)eradication on intestinal metaplasia(IM)prevention is controversial.The purpose of this meta-analysis is to systematically evaluate the pathological changes of the gastric mucosa in intestinal metaplasia after Helicobacter pylori eradication and conduct a meta-analysis to clarify this association.Methods: The PubMed,MEDLINE,Embase,and the Cochrane Library databases were searched for related studies published in English.We also searched other sites,including the Chinese Biomedical Literature Database.We searched randomized controlled trials(RCTs)up to April 2019,eligible studies were those that divided participants into a Helicobacter pylori treatment group and a placebo/no Helicobacter pylori eradication group.Two authors examined all included articles independently,and disagreements were discussed for resolution.The bias risk of the included studies were assessed by the Jadad scale and Cochrane Reviewers’ Handbook 5.1.0.All analyses were performed using Cochrane’s Review Manager 5.3.The random effect model/fixed effect model was choosed by the magnitude of heterogeneity in diffirent group which was used to show the effects of Helicobacter pylori eradication on pathological progression or regression of the gastric mucosa.And Participants from studies providing individual histology data were divided into 4 subgroups based on Helicobacter pylori treatment(duration of follow-up,country,duration of Helicobacter pylori treatment,and specific Helicobacter pylori treatment),which was uesd to analysis the inpacting factors.And sensitivity analysis was used to exclude the studies that had great influence on the results.Results: Seven studies were included.A total of 991 participants.The selected studies were published between 2000 and 2013.Most of them are in Asia.These are the conclusions: 1.Helicobacter pylori eradication improved the histological scores of intestinal metaplasia in gastric antrum(WMD=-0.17,95%CI:-0.19—-0.14,P< 0.00001)but not in the gastric corpus(WMD=-0.02,95%CI:-0.07— 0.04,P= 0.57).2.Subgroup analysis was performed according to the duration of follow-up after eradication therapy.There was no significant difference in the pathological score of gastric antrum between the radical group and the uneradicated group after 3 years and 5 years of follow-up(WMD=-0.23,95%CI:-0.47— 0.00,P= 0.05)/(WMD=-0.09,95%CI:-0.45— 0.28,P= 0.65),and there was no significant difference between the two subgroups(P= 0.50);There was no significant difference in the pathological score of gastric corpus between the eradication group and the non-eradication group after 3-year follow-up and 5-year follow-up(WMD= 0.05,95%CI:-0.08— 0.18),P= 0.45)/(WMD=-0.07,95%CI:-0.21— 0.08),P= 0.35),and there was no significant difference between the two subgroups(P= 0.23).3.Subgroup analysis according to different countries.There was no significant difference in the pathological score of gastric antrum between the eradication group and the non-eradication group in China(WMD=-0.15,95%CI:-0.31— 0.00,P= 0.06).The pathological score of gastric antrum in eradication group was lower than that in non-eradication group in Japanese,and it showed significant difference(WMD=-0.17,95%CI:-0.20—-0.14,P< 0.00001).There was no significant difference between the two subgroups(P= 0.84);There was no significant difference in the pathological score of gastric corpus between the eradication group and the non-eradication group in China and Japan(WMD=-0.02,95%CI:-0.09— 0.05,P= 0.56)/(WMD=-0.07,95%CI:-0.21— 0.08),P= 0.35).There was no significant difference between the two subgroups(P= 0.55).4.By proton pump inhibitor(PPI)-based triple therapy(7-day trantment duration),the pathological score of gastric antrum of patients with intestinal metaplasia was improved as compared with that in non-eradication group(WMD=-0.17,95%CI:-0.20—-0.14,P< 0.00001);There was no significant difference in gastric corpus between the two groups(WMD=-0.01,95%CI:-0.07— 0.05,P= 0.73).5.Subgroup analysis was carried out according to the different duration of Helicobacter pylori treatment.There was no significant difference in the pathological score of gastric antrum between the eradication group and the non-eradication group in the 14-day duration group(WMD=-0.25,95%CI:-0.80— 0.30,P= 0.37).In the 7-day duration group,the pathological score of gastric antrum in the eradication group was lower than that in the non-eradication group(WMD=-0.17,95%CI:-0.20—-0.14,P< 0.00001),and there was no significant difference between the two subgroups(P=0.78);There was no significant difference in the pathological score of gastric corpus between the eradication group and the non-eradication group in the 14-day duration group and the 7-day duration group(WMD=-0.43,95%CI:-0.96— 0.10,P= 0.11)/(WMD=-0.01,95%CI:-0.07—0.05,P= 0.73).There was no significant difference between the two subgroups(P= 0.12).6.Subgroup analysis according to specific Helicobacter pylori treatment.There was no significant difference in the pathological score of gastric antrum between the eradication group and the non-eradication group in the bismuth-based triple therapy group(WMD=0.15,95%CI:-0.13— 0.43,P= 0.29).The pathological score of gastric antrum in the eradication group was improved compared with that in the non-eradication group by proton pump inhibitor-based triple therapy(WMD=-0.17,95%CI:-0.20—-0.15,P< 0.00001).There was significant difference between the two subgroups(P=0.02);There was no significant difference in the pathological score of gastric corpus between the eradication group and the non-eradication group whether by bismuth-based triple therapy or the proton pump inhibitor-based triple therapy(WMD=-0.18,95%CI:-0.73— 0.37,P= 0.52)/(WMD=-0.01,95%CI:-0.07— 0.04,P= 0.61).There was no significant difference between the two subgroups(P=0.56).Conclusion: Eradication of Helicobacter pylori can improve the pathological score of gastric antrum in patients effectively with intestinal metaplasia,especially in Japan,by proton pump inhibitor-based triple therapy and 7-day duration of eradication,but it has nothing to do with the duration of follow-up.And there was statistically significant difference in the efficacy between proton pump inhibitor-based triple therapy and bismuth-based triple therapy in the gastric antrum.There was no significant improvement in the pathological score of gastric corpus. |
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