Esophagus to Small Intestine
Helicobacter. 2022;27(1):e12860
Impact of smoking on the eradication of Helicobacter pylori
Background and aim: Although the association between the eradication of Helicobacter pylori and smoking has been confirmed through a meta-analysis, many new studies have reported inconsistent conclusions. An up-to-date meta-analysis based on published relevant studies was conducted in this study to address this issue.
Methods: Eligible studies up to January 2021 were screened and retrieved using PubMed and Web of Science as well as by performing a manual review of references. The authors calculated the pooled odds ratios (ORs) with the 95% confidence interval (CI). Subgroup and sensitivity analyses were also performed. Begg’s test was used to determine the publication bias.
Results: In total, 39 studies were included in the meta-analysis. The results showed that smoking increases the failure rate of H. pylori eradication treatment (OR = 1.70, 95% CI: 1.49–1.93). The risk of failure also increases with an increase in the smoking dose (> 5 cigarettes per day; OR = 2.59, 95% CI: 1.28–5.24) and the current smoking status (continued to smoke during treatment; OR = 2.49, 95% CI: 1.52–4.06). Studies with a large proportion of patients with peptic ulcer (OR = 2.14, 95% CI: 1.51–3.02) revealed a higher failure rate among smokers than those with a low proportion of patients with peptic ulcer (OR = 1.57, 95% CI: 1.36–1.81). When vonoprazan was used to treat H. pylori infection, smoking did not affect the eradication rate (OR = 0.94, 95% CI: 0.51–1.75).
Conclusion: Smoking increases the failure rate of Helicobacter pylori eradication treatment. The risk of H. pylori eradication failure in smokers increases with a current smoking status and a high smoking dose. However, when vonoprazan is used to treat the H. pylori infection, smoking has no effect on the eradication rate.