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The relationship between Helicobacter pylori infection and recurrent aphthous stomatitis: a systematic review and meta-analysis

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Abstract

Objective

This meta-analysis was designed to provide new insights into the relationship between Helicobacter pylori (H. pylori) infection and recurrent aphthous stomatitis (RAS).

Materials and methods

We included and evaluated studies on H. pylori infection and RAS from PubMed, EMBASE, Cochrane Library, and Web of Science databases published up to January 31, 2023. The characteristics of these studies were collected, and the quality was evaluated by Newcastle-Ottawa Scale (NOS). The random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). To further explore the sources of heterogeneity, meta-regression analysis and subgroup analyses were performed. Funnel plot, Egger’s test, and Begg’s test were used to assess publication bias.

Results

In total, fifteen case-control studies with 1137 individuals (601 cases and 536 controls) were included. The H. pylori was found to be significantly associated with RAS (OR: 1.83 95% CI: 1.41–2.37, P = 0.001). In the subgroup analyses, studies that used PCR (OR: 2.03 95% CI: 1.31–3.15) or UBT (OR: 1.83 95% CI: 1.13–2.96) yielded a significant positive association, while a non-significant association (OR: 1.12 95% CI: 0.61–2.08) was found from studies that used ELISA method. Sensitivity analyses showed that the results were robust. No significant publication bias was found.

Conclusions

The current evidence does not rule out an association between H. pylori and RAS. The effect of H. pylori on RAS varies in detection methods and sources of sample. Large samples, multiple clinical studies, and improved methods are still needed to determine the exact effect of H. pylori on RAS.

Clinical significance

H. pylori infection may be a risk factor for the pathogenesis of RAS.

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Data availability

The original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.

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Acknowledgements

Thanks to James K. H. Tsoi, Hangzhou Qiantang Specialty Appointed Expert (Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou), for his supervision and guidance on this article.

Funding

This work was supported by the Program of Xinmiao Talents in Zhejiang Province (grant no. 2022R41A044) and Innovation and Entrepreneurship Training Program for College Students of Zhejiang Province (grant no. S202210344118).

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Authors and Affiliations

  1. School of Stomatology, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China

    Jiayan Shen, Zhenyan Ye, Haohui Xie & Yun Chen

  2. The Stomatology Hospital of Zhejiang Chinese Medicine University, Hangzhou, 310053, Zhejiang Province, China

    Yun Chen

  3. School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China

    Yue Wu

  4. Department of General Dentistry, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, Zhejiang Province, China

    Danhua Ling

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Contributions

Y. Chen: Study concept and Writing –review & editing, Supervision, Visualization. Y. Wu: Study design and Writing – review & editing. J. Shen: Conceptualization, Methodology, Formal analysis, Writing – original draft. Z. Ye: Methodology, Investigation, Formal analysis. H. Xie: Methodology, Investigation, Formal analysis. D. Ling: Conceptualization, Writing – review & editing, Supervision. The authors had full access to the data and take full responsibility for the results. All authors contributed to the article and approved the submitted version.

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Correspondence to Yue Wu or Yun Chen.

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Shen, J., Ye, Z., Xie, H. et al. The relationship between Helicobacter pylori infection and recurrent aphthous stomatitis: a systematic review and meta-analysis. Clin Oral Invest 27, 6345–6356 (2023). https://doi.org/10.1007/s00784-023-05273-y

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