Association between Active Helicobacter pylori Infection and Glaucoma: A Systematic Review and Meta-Analysis

Michael Doulberis; Apostolis Papaefthymiou; Stergios A Polyzos; Panagiotis Bargiotas; Christos Liatsos; David Shiva Srivastava; Christos Zavos; Panagiotis Katsinelos; Jannis Kountouras

doi:10.3390/microorganisms8060894

Association between Active Helicobacter pylori Infection and Glaucoma: A Systematic Review and Meta-Analysis

Microorganisms. 2020 Jun 13;8(6):894. doi: 10.3390/microorganisms8060894.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland.
² Department of Internal Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Macedonia, Greece.
³ First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 55134 Thessaloniki, Macedonia, Greece.
⁴ Department of Emergency Medicine, University Hospital Inselspital Bern, Bern, 3010 Bern, Switzerland.
⁵ Department of Gastroenterology, University Hospital of Larissa, 41110 Larissa, Greece.
⁶ Department of Neurology, Medical School, University of Cyprus, Nicosia 2029, Cyprus.
⁷ Department of Gastroenterology, 401 General Military Hospital of Athens, 11525 Athens, Greece.

Abstract

Background: Glaucoma is the second most common cause of blindness worldwide affecting almost 70 million individuals. Helicobacter pylori (H. pylori) is a widespread pathogen with systematic pathogenicity. This meta-analysis aimed to estimate the contradictory data regarding a potential association between active H. pylori infection and glaucoma. Materials and Methods: A research in MEDLINE/PubMed and Google Scholar was conducted and original studies investigating the relationship between H. pylori infection and glaucoma were included. Analysis was performed with random effects model. The main outcome was the odds ratio (OR) with 95% confidence intervals (CI) of H. pylori infection as a risk factor for glaucoma. A parallel analysis studied the role of active infection as indicated by histology and the titer of anti-H. pylori antibodies. For the anti-H. pylori antibody titers, weighted mean differences (WMD) were estimated between patients and controls. Results: Fifteen studies were included, with 2664 participants (872 patients with glaucoma and 1792 controls), divided into primary open-angle glaucoma (POAG), normal tension glaucoma (NTG) and pseudo-exfoliation glaucoma (PEG). The association between H. pylori infection and overall glaucoma was significant (OR = 2.08, CI 95% 1.48-2.93) with moderate heterogeneity (I² = 61.54%). After stratification by glaucoma subtype, heterogeneity was eliminated in the NTG subgroup. Studies with healthy controls, and controls with anemia yielded very low or no heterogeneity, respectively. Gastric biopsy to document active H. pylori infection yielded the highest OR (5.4, CI: 3.17-9.2, p < 0.001) and null heterogeneity. For anti-H. pylori antibody titers, there was a significant difference in WMD between patients and controls (WMD 15.98 IU/mL; 95% CI: 4.09-27.87; p = 0.008); values were greater in glaucoma patients, with high heterogeneity (I²: 93.8%). Meta-regression analysis showed that mean age had a significant impact on glaucoma (p = 0.037). Conclusions: Active H. pylori infection may be associated with glaucoma with null heterogeneity, as, beyond histology, quantified by anti-H. pylori titers and increases with age.

Keywords: Helicobacter pylori infection; glaucoma; primary open-angle glaucoma; pseudo-exfoliation glaucoma.

Publication types

Review