Is there an association between infection and irritable bowel syndrome? A meta-analysis.

Background: Irritable bowel syndrome (IBS) is a prevalent and debilitating gastrointestinal condition. Research has reported persistent, low-grade mucosal inflammation and significant overlaps between patients with IBS and those with dyspepsia, suggesting a possible pathogenic role of () in IBS. This study therefore aimed to provide the first systematic review and meta-analysis on the association between infection and IBS.

Aim: To investigate the association between infection and IBS.

Methods: Using the keywords " OR Helicobacter OR Helicobacter pylori OR infection" AND "irritable bowel syndrome OR IBS", a preliminary search of PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, Web of Science, Google Scholar and WanFang databases yielded 2924 papers published in English between 1 January 1960 and 1 June 2018. Attempts were also made to search grey literature.

Results: A total of 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis. Random-effects meta-analysis found a slight increased likelihood of infection in patients with IBS, albeit this was not statistically significant (pooled odds ratio 1.47, 95% confidence interval: 0.90-2.40, = 0.123). It must also be acknowledged that all of the available studies reported only crude odd ratios. eradication therapy also does not appear to improve IBS symptoms. Although publication bias was not observed in the funnel plot, there was a high degree of heterogeneity amongst the studies included in the meta-analysis ( = 87.38%).

Conclusion: Overall, current evidence does not support an association between IBS and infection. Further rigorous and detailed studies with larger sample sizes and after eradication therapy are warranted.