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Association between Helicobacter Pylori infection and stroke: a meta-analysis of 273,135 patients

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Abstract

Background

Stroke stands among the most leading causes of mortality worldwide. Although modifiable risk factors for stroke have been identified, current risk factors do not sufficiently explain the risk in young patients. Previous studies have postulated an association between infection by Helicobacter pylori (HP) and stroke.

Objective

To investigate the association between HP infection and stroke by using a systematic review and meta-analysis approach.

Methods

Four electronic search engines/libraries were systematically searched for relevant observational studies. Studies were screened for eligibility and data were extracted. The odds ratio (OR) and 95% confidence interval (95% CI) were combined under the random-effect model. The protocol was registered in PROSPERO (CRD42019123689).

Results

Among the included studies, 25 studies were analyzed for anti-HP IgG, 9 studies were for anti-Cag A, and 6 studies were for the C-urea breath test. The results showed that positive anti-HP IgG was significantly associated with an increased risk of stroke [OR (95% CI) = 1.43 (1.25–1.46)]. Similarly, both antiCag A and C-urea breath test were significantly associated with an increased risk of stroke with [OR (95% CI) = 1.77 (1.25–2.49)], and [OR (95% CI) = 2.21 (1.33–3.66)], respectively. Furthermore, our results indicated that positive anti-HP IgG was associated with stroke caused by atherothrombosis and small artery disease.

Conclusions

This study suggests that HP infection is significantly associated with increased risk of stroke. However, more well-designed studies are required to investigate if early HP eradication might decrease the incidence of stroke.

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Author notes

  1. Mohamed Fahmy Doheim, Ahmad Amr Altaweel and Mohamed Gamal Elgendy contributed equally to this study.

Authors and Affiliations

  1. Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Mohamed Fahmy Doheim, Ahmad Amr Altaweel, Mohamed Gamal Elgendy, Alaa Ahmed Elshanbary, Amira Abo Hegil Abo Ali, Toqa Mahmoud Dahy & Atef Khairy Sharaf

  2. College of Medicine, Sulaiman Al Rajhi University, Qassim, Saudi Arabia

    Mahmoud Dibas

  3. Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, USA

    Ameer E. Hassan

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  1. Mohamed Fahmy Doheim
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Contributions

MFD participated in generating the idea and the designing the study. MD conducted the statistical analysis. All authors participated in screening studies, collecting data, drafting the manuscript, and approving its final form. AEH supervised the team for any needed instructions and performed critical revisions of the manuscript.

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Correspondence to Ameer E. Hassan.

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Doheim, M.F., Altaweel, A.A., Elgendy, M.G. et al. Association between Helicobacter Pylori infection and stroke: a meta-analysis of 273,135 patients. J Neurol 268, 3238–3248 (2021). https://doi.org/10.1007/s00415-020-09933-x

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